WAN Implementation - Links and Bandwidth

By powder21 ·
I am currently working on my final project for my Associates Degree in Networking and I need some help with deciding how much bandwidth I will require over the WAN and what type of WAN link to use. I already have a design in mind but it may be too much.

First, some details...
There is one central office and four remote offices each within about 10 miles of the central office.

The CO will contain the DC, Web Server, and Application Servers accessed by the ROs. Part of what will be hosted on these servers is medical management software and a patient database.

There will be 75 workstations total. 15 at the CO, 12 at each RO, and 12 Notebooks which can access any of the RO LANs at any given time. All of these require high speed internet access.

We have also chosen to use a hosted IP PBX system with about 51 phones on the network ranging from 7-14 at each office.

We want to place one FiOS (50Mbps/20Mbps) internet connection at the CO and filter it to the ROs. With all of this, I'm assuming a lot of data traffic on the WAN links. I was planning on a hub and spoke config with a dedicated (leased) DS3 line connecting each RO to the CO (that's 4 DS3 lines). I was figuring that this MIGHT be enough to allow all users high speed internet from the one internet connection, provide for the IP Telephony needs, and have enough left over for internal traffic.

1. Is this too much or too little?
2. Would frame-relay be a better option?
3. Will I require FiOS at each location instead of just one?

Budget constraints are not a big issue here and remember that the sites connected by WAN are only 10 miles apart. I also need some redundant connectivity and was thinking about backup ISDN lines for each WAN link. I would REALLY appreciate your thoughts. Thanks you.

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All Answers

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RE: 1. Is this too much or too little?

by OH Smeg Moderator In reply to WAN Implementation - Link ...

Depends on the type of business and what if any need there is for Internet connection.

But Medical D Bases if used in the treatment of patients consume an enormous amount of Bandwidth.

Would frame-relay be a better option?

Again depends on the type of Business and what if any safeguards need to be implemented to protect Patient Confidentiality.

Will I require FiOS at each location instead of just one?

Again depends on the type of business in use here. There is also a need to comply with Data Protection Laws in the different locations around the world or at the very least the country that this supposed business is located in.

You would also need an enormous amount of Security which can consume bandwidth as well. But it depends on if there are real life patients being treated or if this is just a Medical Supply Company who sell Hardware of some kind. If this was a Medical Practice the NB's may prevent the place meeting any Compliancing Rules in place.


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Thanks...This is a Medical Practice

by powder21 In reply to RE: [i]1. Is this too muc ...

First, thank you very much for your reply...I would like some more help if you don't mind.

1. The medical databases WILL be used in treating patients. I figured that this would require quite a bit of bandwidth. The organization will consist of nine doctors (as well as nurses and other staff of course).

2. I was under the impression that the dedicated point to point connections would provide better security than frame-relay.

3. This will be located in California, US

4. We are using EMR and each of the nine doctors will have a notebook for use when seeing patients. They want the ability to see patients at any site if needs be. Our Practice Management/EMR software is completely HIPAA compliant.

Now that you know the nature of the business, I was hoping you could now elaborate on your answers. Thanks again.

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OK I'll give it a go but as I'm in AU I don't know the Laws in CA

by OH Smeg Moderator In reply to Thanks...This is a Medica ...

But yes you are right a Dedicated Point to Point is more secure but it all depends on what The Powers That Be say on this they in the form of Bureaucratizes have not been known to be overly clever when Legislating Rules that Medical Professionals have to work under.

But from my experience NB's and Medical Practices are not a good mix as when the NB gets lost stolen and this does happen far more than some people realize it is possible depending on the setup that the thief could have access to the Medical Records. It is much better to setup Roaming Profiles and allow the different Desktops to access the Required Files that way.

Also if there is any Compliencing involved here it may not even be possible to to use NB's or some of the other setup and get Accredited.

The Support Staff should only have limited access the the DBase as well so that they can make appointments or follow any treatment directions given. They shouldn't have Cart Blanc Access to the Patient DBase and while that will save some Bandwidth it will also consume more preventing them access to certain areas.

While the Practice Management Software may be HIPAA Compliant what about the remainder of any Compliencing Issues involved here. When I used to do Medical Work a lot NB's where a Big No No. I have seen practices having to dump new NB's and replace them with Desktops to get accredited here so that was what I was thinking about. Instead of giving the Quacks individual Computers it is better to give them an Individual Roaming Profile which allows them to use different hardware and get the required Data. It also keeps the computers under your control so that they don't get used to play games and Surf Porn Sites After Hours where they get infected and possibly compromise the System.

Just remember that Doctors are not interested in learning how the system works they just want to use it to make their lives easier so think of them as Dumb End Users when it comes to the Computer Systems. You need to make the System Fool Proof as mistakes will get made and this can be expensive when things nasty happen. You'll also be the one to get the blame as well I might mention as the Medical Professionals will not willingly accept the responsibility for their mistake they will say things like I wasn't Told that or I didn't Know and want to pass the blame back to the person who designed and implemented the system. Here we allow Quacks to use NB's but never to connect them to the Network for anything. They can bring in their NB's and do presentations in Teaching Institutions but they are never allowed to connect these NB's into the Practice Networks where they can access patient Data. We even currently have a major issue with a Thumb Drive being lost that contained a Power Point Slide Show that was used for Quack Training. The Quack in question dropped it and while it held no actual data that could identify any individual it did hold a Treatment Procedure that was not supposed to be shown anywhere but in the Training Institution.

Don't get me wrong I'm not calling the Quacks Stupid but they just are not trained in IT so what is important there they don't know and they are more concerned in getting things done in their job and they don't worry about the computers as they are working. When they stop that is when they start to get worried. I have a Surgeon here who I still support because he blackmails me and he is of the opinion that as long as the computer is working it's good. I tried for 6 months to get in and replace a AV Product that had expired on his computer and he was always Too Busy Naturally when he got a E-Mail from the Royal College of Surgeons telling him that his computer was infected it had to be fixed Immediately and preferably yesterday.


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I appreciate the advice on security

by powder21 In reply to OK I'll give it a go but ...

Unfortunately, notebooks are a necessity in this particular practice. I have actually spoken with a couple of doctors about this issue. Many practices where I'm at are now using notebooks to see patients in place of charts in order to conform to the new EMR standards that our country has put in place. I understand the security risks, but it is certainly in compliance. The Doctor's notebooks will be denied internet access and will be kept in storage (under lock and key) at the actual facility when they go home.

I don't want this to sound unappreciative of what you've told me (because I'm very happy to hear your thoughts on the issue), but I was hoping more for your ideas on bandwidth requirements (whether or not we will actually require 45Mbps connections to each remote office). I recently spoke with another IT Professional who is recommending that we go with MPLS for our WAN connections. Have you had experience with that? Thanks again and I hope to see another reply soon.

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OK in that case

by OH Smeg Moderator In reply to I appreciate the advice o ...

Firstly I have to say I don't like using the term Doctor as it denotes some thing to do with the Medical Profession to most people and the majority of Doctors are not trained in Medicine. But that could just be because I have a couple of phud's and when some idiot makes reservations for things and uses the DR bit I've gotten asked to look at Medical Emergences no fun that at all.

Many practices where I'm at are now using notebooks to see patients in place of charts in order to conform to the new EMR standards that our country has put in place

Have you considered Net Books here instead of Note Books? As Charts for In Patient Treatment this is a better idea and a more secure option as Net Books don't have all of the connections that a Note Book has. The Selling side to the Medical Staff and Accountants is that they are cheaper and because of the smaller Screens slightly more robust.

But on the Bandwidth Issues this all depends on what type of Practice it is. Naturally a Specialist Patrice would require more Bandwidth than a General Practice where they are just handing out prescriptions. So if for argument sake this was a Cancer Specialist who was dealing in Radiation Therapy they would use lots of Bandwidth.

Here you need to look at the individual Patient Records well their Size at least and get some idea of just what is involved when the individual patient records are opened by the Medical Staff. Then work out how many Patients per day in which office will be seen and work out an estimated Bandwidth required just by the Md's. Then triple it for that office and you will be getting close to the Maximum per Day Data Transfer required under peek loadings.

Instead of taking an average here you need to work out what the load at each office will be under the Maximum Loading and then add in a safety Margin to allow for some growth. From past experience I have found that in a General Practice 3 Times the Md's Data Loading is sufficient for that location and gives a small amount of Growth but this is very fluid as it all depends on what is done in the practice.

If for instance 1 MD comes in and then instructs 5 Nurses to do something the Nursing Side would have the greatest Data Requirement so you need to look at what is using the most Data and work from there. Unfortunately with Medical things like this they need the Data Now and can not afford to wait for even a few minutes so you need to overestimate the required Bandwidth and build in lots of Redundancy. So one link to the Central Office where the records are kept will not be enough you'll need some Backup in the event of a Failure occurring.

As for the actually requirement I'm not fully sure as this depends on what the Patrice is doing but if you follow the above that is a starting point to work from. Just do not forget Pathology Results and any Video of Pathology that may be required for the Patients if this place does that type of thing. In some Oncology Specialists that I used to work for they had a massive Data Requirement when the Quacks wanted to open some of the Pathology reports read that as Videos of the Tests things like Eco's and other Visual Type Pathology.

Lets know if that was of any help.


edited to add better still drop me a Peer Mail to get this off a Public Forum.

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Those are great standards to go by, but...

by powder21 In reply to OK in that case ;)

1. Unfortunately for me, this is a final project for school and, as such, we do not have an actual business to gauge requirements. All I can tell you is that this is a "General Practice", but there will be "visiting specialists" from time to time. This is why I was hoping for generalities since you seem to have experience in the area. If you could possibly provide me with some of these general bandwidth needs (maybe some examples) based on what you've encountered, it would make all the difference in the world. I've tried talking to providers from different practices, but (duh) they have no idea because they're Quacks.

2. I have considered using netbooks...still looking into it.

I should add that there will be 144 end-user devices accessing the network in the organization...including workstations, phones, printers, faxes. Not including servers, switches, routers of course.

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Didn't read Oh Smegs suggestion but

by CG IT In reply to OK in that case ;)

How your network is setup will depend in a very large part on whether you must comply with HIPAA regulations. If you do, then how you handle protected data on the network would determine your how you setup transmitting such data either on the LAN or on the WAN. Thus is anyone access ePHI data remotely must do so over a secure link [encrypted]. Bandwidth aside, your routers must be able to support that along with ensuring that data can't be compromised or changed.

Many MD offices that I have worked on use something like sharepoint services where data is centrally located. Requires at least 2 factor authentication. That logs can identify who accessed what and when. And that the data was not changed end to end unless authorized (which must also be documented). Designing the network must take in consideration all the regulations that the business must comply with. Armed with the regulations one must comply with, designing the network to comply with them as well as provide a usable worker experience will determine what you need.

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Please sir, can I have some more? :-)

by powder21 In reply to Didn't read Oh Smegs sugg ...

Thanks. We DO have to comply with HIPAA. One of my team members is researching HIPAA compliance (although the research hasn't been very detailed). There will be plenty of ePHI data being accessed remotely.

We will be using Cisco 2800 series routers (most likely) which I'm sure should support such security features. What kind of WAN links support that? I am researching different things like MPLA. I am very interested in using Verizon's E-LAN or EVPL services (ethernet lan / ethernet virtual private line). Do you know if those are encrypted? Are you saying that the WAN links themselves must be encrypted?

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what I'm saying is that you need to do your homework

by CG IT In reply to Didn't read Oh Smegs sugg ...

1. Unfortunately for me, this is a final project for school and, as such, we do not have an actual business to gauge requirements.

If you aren't willing to do the research, well then not going to do it for you. Besides, you aren't learning anything if someone else does the work for you. Especially when it comes to computer technology.

That being said, regulations will determine what you need to comply with. To comply with the regulations you will need dministrative, technical and physical safeguards. These specs will determine the the design of the network from administrative (paperwork) to technical(types of specs, protocols, you will use, and physical equipment to meet the specs.

Go lookup HIPAA regulations. They are very specific on what needs to be done.

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Well then as this is a Trick Question

by OH Smeg Moderator In reply to WAN Implementation - Link ...

There are no right or wrong answers if you do not provide sufficient details on why you chose what you end up with you will be penalized for either spending too much money or not having sufficient security or leaving enough room for usability/growth.

What you have to do here is Justify what you have set out and explain why you chose the setup that you did. So assuming that this is a General Practice staffed by Manic Depressives and does small Day Surgery type Items like stitching up open wounds, Cutting small things out and so on try to go for a Medium Point in the Data Transfer with the Infrastructure that is available in the general location.

The trick here provided you don't go way under requirements or way over is to fully justify your decisions on why you chose what you did so push the Security and Performance sides of things and remember that you need to add room for Data Encryption and Checking so I would ere on the upper side of things when it comes to required Bandwidth, but that is just me of course.

The trick here with these Trick Questions is to fully Document and Justify everything that is chosen so here you have 2 options push the Cost Savings involved or the Security and Performance benefits of whatever you eventually chose. No matter what, you will be open to claims that it's doesn't cover what was asked but that is why the question was asked that way.

I hope that is of some assistance.


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