PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 3 PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 15 Providers Challenge for Treating Infectious Disease Amy Nicole Elders Grand Canyon University Science Communication & Research Bio- 317V-0500 Michael Rothrock September 6, 2019 Abstract Running head: PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 1 High mortality results from infection within healthcare institutions whether community or hospital acquired. Hospitalists provide inpatient care with increasing frequency due to the overwhelming workload upon primary care physicians. However, hospitalists are generalists and are minimally prepared to attend patients with serious infections which may rapidly overwhelm particularly in vulnerable populations. Duplication of diagnostic testing, prolonged length of stay drives up costs for institutions and patients. Erroneous or inadequate prescription of antibiotics costs lives, Infectious disease specialists are inadequately utilized despite statistical evidence that such specialty care improves outcomes. Education, collaboration between providers, and prescribing guidelines are recommended to address these needs. Providers Challenge for Treating Infectious Disease Technology has become increasingly advanced and the ability to diagnose, treat, and manage patients is ever evolving. Although advancements in imaging, surgical procedures and medication therapies make possible a better quality of life, they are often required to self-manage very serious disease and infection. Insurance companies and healthcare regulations often guide the path providers must take to care for patients. The length of stay in hospitals are decreasing and patients are being treated on an outpatient basis. Patients often receive care in outpatient rehabs, infusion centers, and home health agencies with medications supplied by specialty pharmacies. Drug resistant organisms are becoming more common and the risks associated with treating these organisms can often be challenging to manage. Treatment is often received for an extended amount of time and many primary care providers no longer see patients on an inpatient basis. This means that hospitalists assume care when they are admitted into the hospital but are unable to follow the patient for the remainder of treatment when they are discharged. When complications arise for these patients, they have limited ways of seeking help. There is fragmented care and lack of continuity. In the case of patients diagnosed with infection, questions about when hospitalists should consult specialists such as infectious disease physicians often occur. Mortality and morbidity for patients as well as hospital stays and readmission are decreased when an Infectious Disease physician is consulted early (CDC, 2013). Research is focused on the education of these two types of physicians, why some providers decide not to pursue a specialty, as well as success rates of patients treated by both. Fact ...

1. PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 3
PROVIDERS CHALLENGE FOR TREATING INFECTIOUS 15
Providers Challenge for Treating Infectious Disease
Amy Nicole Elders
Grand Canyon University
Science Communication & Research
Bio- 317V-0500
Michael Rothrock
September 6, 2019
Abstract
Running head: PROVIDERS CHALLENGE FOR TREATING
INFECTIOUS 1
High mortality results from infection within healthcare
institutions whether community or hospital acquired.
Hospitalists provide inpatient care with increasing frequency
due to the overwhelming workload upon primary care
physicians. However, hospitalists are generalists and are
minimally prepared to attend patients with serious infections
which may rapidly overwhelm particularly in vulnerable
populations. Duplication of diagnostic testing, prolonged
length of stay drives up costs for institutions and patients.
Erroneous or inadequate prescription of antibiotics costs lives,
Infectious disease specialists are inadequately utilized despite

2. statistical evidence that such specialty care improves outcomes.
Education, collaboration between providers, and prescribing
guidelines are recommended to address these needs.
Providers Challenge for Treating Infectious Disease
Technology has become increasingly advanced and the ability to
diagnose, treat, and manage patients is ever evolving. Although
advancements in imaging, surgical procedures and medication
therapies make possible a better quality of life, they are often
required to self-manage very serious disease and infection.
Insurance companies and healthcare regulations often guide the
path providers must take to care for patients. The length of stay
in hospitals are decreasing and patients are being treated on an
outpatient basis. Patients often receive care in outpatient
rehabs, infusion centers, and home health agencies with
medications supplied by specialty pharmacies. Drug resistant
organisms are becoming more common and the risks associated
with treating these organisms can often be challenging to
manage. Treatment is often received for an extended amount of
time and many primary care providers no longer see patients on
an inpatient basis. This means that hospitalists assume care
when they are admitted into the hospital but are unable to
follow the patient for the remainder of treatment when they are
discharged. When complications arise for these patients, they
have limited ways of seeking help. There is fragmented care and
lack of continuity. In the case of patients diagnosed with
infection, questions about when hospitalists should consult
specialists such as infectious disease physicians often occur.
Mortality and morbidity for patients as well as hospital stays
and readmission are decreased when an Infectious Disease
physician is consulted early (CDC, 2013). Research is focused
on the education of these two types of physicians, why some
providers decide not to pursue a specialty, as well as success
rates of patients treated by both. Factors affecting the care of

3. patients, unnecessary testing and treatments, the need for
stewardship programs in hospitals, and other associated issues
are also discussed.
Impact of Infection
Infection is often the diagnosis for admission into the hospital
for many patients. However, infections can also be acquired or
developed in the hospital. “Some common infections include
clostridium difficile, bacteremia, central line associated
bloodstream infections (CLABSI), bacterial endocarditis,
HIV/opportunistic infections, meningitis, osteomyelitis,
prosthetic joint infections, septic arthritis, septic shock and
vascular device infections” (Schmitt, 2013, para 3). Whether
infection develops in or out of the hospital, many causative
organisms become resistant to treatment. When this occurs,
successful treatment becomes much more challenging.
“Infections are among the top leadings causes of death in the
United States” (Schmitt, 2013, para 1). Additional testing
including specific blood analyses, cultures of the infected sites,
stool samples, aspirate of infected area, biopsy, or imaging are
often ordered to determine causative organism(s) and to what
antibiotic it is sensitive. After results have been obtained from
diagnostic testing and bloodwork, then assessment of the
patient’s health status, medication profile, and allergies must be
considered. Once treatment decisions are determined, insurance
coverage and approval also must be obtained; and the physician
must order what they deem as necessary and best practice. The
question then becomes not only what treatment is necessary, but
what provider and what setting is best suited to optimize care
for the patient. Resource utilization is key.
Hospitalist Care
Workload increase is experienced by physicians as they struggle
to meet the demands of facilities where they practice. “Hospital
administration and financial officers demand increased

4. productivity by physicians to compensate for decreased revenue
from insurance companies” (Elliott et al., 2014, p.786).
Consequently, primary care providers often admit patients under
the care of hospitalists. “Hospitalists are not required to have
additional years of subspecialty training and often are paid
higher wages than a board-certified infectious diseases
physician, work in shifts with extended periods of time off, and
have no outpatient overhead or responsibilities” (Chandrasekar
et al., 2014, p.1594). While this lifestyle is attractive to
physicians, it often negatively impacts continuity of care in the
outpatient setting. Patients who are discharged from the hospital
must follow up with their primary care provider or specialists if
needed as there is no outpatient practice for the hospitalists who
cared for them while hospitalized. Patients who do not have
primary care providers must seek follow up care in a resource
clinic, mission clinic, or emergency room if complications arise.
This increase in the workload, revealed in a recent survey of
hospitalists, that more than 40% feel that they are exceeding
what they perceived as a safe workload at least monthly and that
increased workload led to delays in care, poor communication
between physicians and patients, delivery of unnecessary care,
medication errors, and complications of care, including death
(Elliott et al., 2013, p.786).
These statistics are concerning as many patients whom the
hospitalists care for often have difficult infections to treat. The
question of when to consult an infectious disease physician to
care for a patient is often a controversial issue among
hospitalists.
Infectious Disease Specialist
The infectious disease (ID) physician is a resource who often is
not effectively utilized in the hospital setting. ID have a
specialized knowledge of drug resistant organism(s), new
emerging pathogens, and geographical locations where infection
occur. “Their education includes an emphasis on infection
control, quality improvement, and antibiotic stewardship.
Numerous hours are spent on presentations, meetings, and

5. researching topic that deal with infectious disease and
diagnostic microbiology” (Chandresekar et al., 2014). The lack
of consultation for ID is often due to patients initially being
admitted under hospitalist care. Hospitalists must understand
the extent of the knowledge base of an ID physician, therefore
see the need to consult them early for the best patient outcome.
The incentive to study this career path is often not as attractive
as the ever-growing hospitalist path. Recruiters of applicants
for the infectious disease specialty have surveyed some reasons
for possible shortages. Program directors of medical schools are
offering some solutions to target graduates to apply for the
infectious disease specialty.
It is time to review, update, and expand the syllabi for
infectious diseases in medical school curricula. . . . Increasing
knowledge and experience among medical students in areas of
global health, HIV infection, antibiotic stewardship, and
diagnostic microbiology would hopefully increase the pool of
future applicants. The infectious diseases faculty (practitioners)
need to work toward a mandatory rotation in infectious diseases
for all internal medicine residents, (Chandrasekar et al., 2013,
p. 1596).
Promotion of infectious disease topics with global attention and
involvement is important as well for ID physicians. Although
this field is very specialized, these physicians must also be
afforded opportunities to participate with other sub-specialties
regarding research and patient care. Interdisciplinary meetings
with those who are involved more specifically in tropical
medicine, or third world countries where the development of
epidemics occur can also prove beneficial in the education of ID
providers.
Educating Hospitalists and Improving Antibiotic Utilization
Inappropriate use of antibiotics and hospital acquired infections
are both major concerns for the general public. Hospitalists are
among the top physicians who admit patients with infection into
the hospital, and the need to educate them to coordinate patient

6. care with other healthcare providers is important. Patients with
serious infections under the care of hospitalists only experience
longer length of stay and higher mortality and morbidity rates
(Kisuule, 2008). “More than 70% of hospital acquired infections
are resistant to at least one commonly used drug” (Kisuule et
al., 2008, p. 64). Five categories involving inappropriate use of
antibiotics include: 1) antibiotics given for illnesses for which
they are not indicated; 2) broad spectrum antibiotics overuse in
the empiric treatment of common infections; 3) intravenous
antibiotics prescribed for infection when oral agents would be
similar; 4) inappropriate antibiotic dosage, schedule, and/or
duration of treatment when the correct antibiotic choice is
made; and 5) mismatch when susceptibility studies indicate that
the drug being used is ineffective or only marginally effective
i.e. “bug-drug” error (Kisuule, 2008). Formulating a model to
guide antibiotic prescribing, developed with participation of
providers including hospitalists is an important step in
educating frontline providers and enhancing patient safety.
Antimicrobial Stewardship Programs
In the acute care setting, many facilities are adopting
antimicrobial stewardship programs (ASP). The focus of these
programs is to offer guidelines for physicians treating
community or hospital acquired infections and facilitates. As
hospitalists are often generalists, ASP allows them to feel
comfortable prescribing antibiotic therapies in collaboration
with or in the absence of ID physicians. It is important for
patients to trust that the goal of the hospitalist is to achieve the
best patient outcome while increasing knowledge base and
promoting communication between providers. This helps to
enhance patient experience, improve population health, reduce
cost, and improve the work life of healthcare providers
(Bodenheimer and Sinsky, 2014). “Reducing the use of
antimicrobials where they are not indicated will slow down the
emergence of antimicrobial resistance while ensuring
antimicrobials remain an effective treatment, improving clinical
outcomes, conserving resources” (NICE, 2015). The

7. antimicrobial stewardship team should have core members such
as an antimicrobial pharmacist and a medical microbiologist and
contract other members depending on setting and resources
(NICE, 2015). In order to be an affective change agent
education and feedback are required for the healthcare
providers. Data collection is an important part of this process to
not only educate the importance of this change but also
encourage prescribers to reflect on their personal practice.
Implementing checks and balances such as an audit system and
including objectives with a review in annual evaluations of the
providers (NICE, 2015). “Commissioners could support a
change in prescribing practice by using contracts to ensure that
prescribers have the training and skills for antimicrobial
stewardship” (NICE, 2015, p. 5). Information systems are
critical for trending for feedback on prescribing, resistance, and
patient use of prescriptions (NICE, 2015).
Conclusion
The world of infection continues to pose new challenges for
treating patients with infection in both the inpatient and
outpatient setting. The development and identification of new
pathogens, advancements in diagnostic technology, and new
antimicrobial therapies, the medical profession will undoubtedly
continue to change and fine tune how they treat infectious
diseases. Although hospitalists are considered a specialty, they
have many aspects of a patient’s health to oversee including
infection. Their knowledge base is vast and broad while
infectious disease physicians have numerous hours dealing
specifically with infection. They are faced with limited length
of stays, an increased workload in the hospital, and their job is
considered complete when the patient is discharged from the
hospital. Infectious disease will further investigate the cause
and the extended treatment of infection and possibly discuss
prevention of reoccurrence and readmission for the same
diagnoses. Hospitalists and infectious disease physicians are
challenged to collaborate, communicate, and educate in an
environment of transparency to strengthen antimicrobial

8. stewardship programs for the delivery of high -quality care
Annotated Bibliography
Research topic will be benefits and risks of having the care of a
specialist such as infectious disease, compared to hospitalist
care in the inpatient care setting.
Gupta, S., Bansal, A., Newman, E. & Martin, S. (2017).
Opportunities in the Acute Care Setting for Infectious
Diseases/Hospitalist Patient Co-Management. Open Forum
Infectious Diseases,4(1), S328–S329.
doi.org/10.1093/ofid/ofx163.777
This article speaks to the importance of consulting with an
Infectious Diseases physician from the time of admission all the
way to discharge and follow up care for patients. It also
discusses the model of primary care physicians being the one to
consult Infectious Disease leading to missed opportunities in
care, testing, and use of antimicrobial, antifungal, or antiviral
medication use. Lower mortality rates and readmissions being
the benefit of patients seeing the specialist while they are
inpatient is also discussed. The peril of not having the specialist
to see the patients initially and how that can have long term
effects on the patient’s care and overall outcome will be useful
in my paper for comparing some pros and cons on hospitalist or
primary care versus the specialist or Infectious Disease
physician.
Elliott, D. J., Young, R. S., Brice, J., Aguiar, R., & Kolm, P.
(2014). Effect of Hospitalist Workload on the Quality and
Efficiency of Care. JAMA Internal Medicine, 174(5), 786. doi:
10.1001/jamainternmed.2014.300
This article discusses some of the issues that hospitalists face
when they have an increased work load in the hospital and how
that can affect patient’s outcome in a negative way. This
supports my research that it is best to consult a specialist when
it comes to infection diagnosis, care, and management. It also
supports the idea that although hospitalists are trained
physicians and can manage many conditions, that certain areas

9. require more time and assessment of patients than others. In
these situations, hospitalists may be overwhelmed with the
number of patients to be seen and are not able to spend this
needed time on patients.
Chandrasekar, P., Havlichek, D., & Johnson, L. B. (2014).
Infectious Diseases Subspecialty: Declining Demand Challenges
and Opportunities. Clinical Infectious Diseases, 59(11), 1593–
1598. doi: 10.1093/cid/ciu656
This article discusses the shortage of applicants in medical
school who apply to the infectious disease specialty.
Awareness of the lack of support for these physicians while
they are residents as well as when they are practicing is
investigated. The need to revamp medical programs to include
more opportunities for providers to spend time in their
specialty. Strong mentorship and fellowship with other sub
specialties for those who are pursuing infectious disease is
suggested. The benefits of a hospitalist lifestyle and some perks
to choosing that path are explored. Discussion about how the
health care reform and other factors affect the desires of new
physicians is also covered.
Pulcini, C., Botelho-Nevers, E., Dyar, O., & Harbarth, S.
(2014). The impact of infectious disease specialists on
antibiotic prescribing in hospitals. Clinical Microbiology and
Infection, 20(10), 963–972. doi: 10.1111/1469-0691.12751
This article discusses how the use of Infectious Disease
physicians influence the quantity and quality of antibiotic use in
the hospital setting and discuss factors that could limit the
efficacy of antibiotics. Appropriate antimicrobial therapy and
ways to identify when oral versus intravenous therapies should
be prescribed are explored. Discussion on how interventions
from the Infectious Disease physicians resulted in an increased
appropriateness of antibiotic prescribing compared to
prescriptions ordered without the influence of an Infectious
Disease physicians. This also describes the antimicrobial
stewardship program in hospitals.
Kisuule, F., Wright, S., Barreto, J., & Zenilman, J. (2008).

10. Improving antibiotic utilization among hospitalists: A pilot
academic detailing project with a public health
approach. Journal of Hospital Medicine, 3(1), 64–70. doi:
10.1002/jhm.278
Hospital setting where hospitalist practitioners discuss
antibiotic prescribing patterns. Motives for chosen prescriptions
are analyzed. Assessing the inappropriate use of antibiotics as a
clinical health problem and public health concern. Actions taken
before, during, and after details given of an intervention and
how this can result in behavior change for the hospitalists or
practitioners in this health setting is researched. Practice based
learning components and improved antibiotic prescribing
practices are found to be successful among hospitalists when
there is the influence of an infectious disease specialist.
Infectious disease specialists are able to collaborate with other
providers and discuss their rationale for prescribing
antimicrobial therapies to inpatients and follow up care upon
discharge.
Nathan, C., & Cars, O. (2014). Antibiotic Resistance —
Problems, Progress, and Prospects. New England Journal of
Medicine, 371(19), 1761–1763. doi: 10.1056/nejmp1408040
This article discusses the recognition of antibiotic resistance,
partnerships for antibiotic discoveries of new drugs, retreat if
antimicrobial research, prevention of the lack of effectiveness,
the need for global collaboration and leadership regarding
antimicrobial therapies, and access to life saving antibiotics. It
also details tailoring antimicrobial therapies to only susceptible
pathogens, and controlled access of drugs. The global action
plan is delivered on antimicrobial therapies. The proposition of
antimicrobial stewardships in health care facilities, communities
as well as collaboration nation- wide is addressed. An increase
in the monitoring of antibiotic effectiveness, renewed interest
and promotion of vaccinations, and attention to sanitation is
discussed.
Redwood, R., Knobloch, M. J., Pellegrini, D. C., Ziegler, M. J.,
Pulia, M., & Safdar, N. (2018). Reducing unnecessary culturing:

11. a systems approach to evaluating urine culture ordering and
collection practices among nurses in two acute care
settings. Antimicrobial Resistance & Infection Control, 7(1).
doi: 10.1186/s13756-017-0278-9
Inappropriate ordering of culturing and samples of various types
continue to be an issue in the field of healthcare. Treating
antimicrobial resistant organisms continues to climb as well.
Investigations of ordering urine cultures and collection
practices among nurses is researched to identify issues and
human factors that may result in unnecessary antimicrobial
therapy. Focus study is in emergency department and intensive
care unit nurses. This would detail how human factors and
foundation of nurses working with patients can affect what
physicians order and what antimicrobial therapies patient may
take and become resistant to. These patients would then benefit
from Infectious Disease physicians per other articles.
Fair, R. J., & Tor, Y. (2014). Antibiotics and Bacterial
Resistance in the 21st Century. Perspectives in Medicinal
Chemistry, 6. doi: 10.4137/pmc.s14459459
This article discusses the rise of antibiotic resistance, the
decrease in pharmaceutical investment, the over prescription of
antibiotics and public misconceptions. Misuse of antibiotics by
the food industry, and human independent resistance, emergent
bacterial threats, and various resistant organisms are also
identified and detailed. Hospital acquired and community
acquired infections along with searches for new antibacterial
agents are discussed as well. This information helps to
emphasize the quantity of these types of infections and the
importance of appropriately prescribing these medications and
not misusing them. Increased education for patients with
information and brochures to ensure knowledge about
antibiotics is encouraged. The use of antimicrobial stewardship
programs to monitor the use of antimicrobial therapies is
explored.
Llor, C., & Bjerrum, L. (2014). Antimicrobial resistance: risk
associated with antibiotic overuse and initiatives to reduce the

12. problem. Therapeutic Advances in Drug Safety, 5(6), 229–241.
doi: 10.1177/2042098614554919
This article describes antibiotic resistance as one of the greatest
threats to humans. The tradition of this being only a clinical
problem in the hospital and the trend of these types of patients
existing in the community and now being treated by primary
care physicians in an outpatient setting instead of specialists for
inpatients. Increased complications in mortality rates,
complications of disease, and more frequent admissions to the
hospital are also a regular occurrence. Higher mortality and
morbidity rates, longer length of stay and readmissions are also
stated. Some interventions to assist with decreasing these
numbers are discussed and suggest for practitioners and all
forms of healthcare providers.
Morley, G. L., & Wacogne, I. D. (2017). UK recommendations
for combating antimicrobial resistance: a review of
‘antimicrobial stewardship: systems and processes for effective
antimicrobial medicine use’ (NICE guideline NG15, 2015) and
related guidance. Archives of Disease in Childhood - Education
& Practice Edition, 103(1), 46–49. doi: 10.1136/archdischild-
2016-311557
This reference supports antimicrobial stewardship programs
including but not limited to implementation, guidelines for
initiation evaluation and ongoing support thereof. The need for
providers to be educated and given feedback regarding their
treatment plan, and their rationale and motive for antimicrobial
therapies ordered. Support staff and stakeholders are discussed
as well as those individuals that would be contracted out to
make these programs successful. Resources and financial
information guidelines are presented as well as tools to assist
administration in evaluating physicians. Benefits and challenges
of having an antimicrobial stewardship program in a healthcare
facility for all parties involved is detailed. The success for
treating infection that is attained when there is the use of an
ASP is discussed as well.

13. Introduction to the Company:
Security Transport Professionals Incorporated (STP), has its
home office located in Lexington, Kentucky and in addition has
more than 3,000 employees located in each of its branch offices
located in Houston, Texas and San Diego, California.
STP is primarily a nationwide freight hauler. Its customer are
comprised of major market retailers particularly in the medical
and pharmaceutical industry, the federal government, and
several state governments. STP operates a fleet of trucks and
private cargo planes that it uses to move “goods” belonging to
its customers from one destination to another across the
continental United States. Its fleet of truck carriers are located
in Lexington, Kentucky with it planes located in Louisville,
Kentucky.
STP carries and transports highly controlled, narcotics and
scheduled prescription drugs, toxic, radioactive, nuclear, and
top secret materials from one facility belonging to its customer
to another. The method of transport depends on the type of
cargo being hauled. In addition to hauling/forwarding its
customers products/goods, STP is required from time to time to
store its customer goods for brief periods of time. Two years
ago STP began contracting with a number of subcontractors
hereafter referred to as either “limited joint partners (LJPs)” or
“independent subcontractor alliances (ISAs)” for the purpose of
expanding its freight forwarding, storage, and delivery service.
Due to the confidential nature of the freight that it transports,
STP vets its employees, as well as any subcontractors (LJPs and
ISAs) that it engages.
STP’s business objectives and goals include the confidential,
safe and secure movement of its customer goods, from the
customer/distributor to its client, or from one of its customer’s
locations to another of the customer’s locations in a timely and
efficient manner using costeffective methods. Alternatively,
STP may transfer this responsibility to one of its limited joint

14. partners
(LJPs) or independent subcontractor alliances (ISAs), if it is
more cost-effective and the income differential is within
acceptable limits. There are 3 LJPs with which STP had entered
into contracts.
LJPs are corporate organizations in the same industry that offer
essentially the same services as STP, and who are generally
competitors of STP. However, when the job requires resources
that exceed those of STP or its competitor, the two will enter
into an agreement to jointly undertake the contract together, and
will together provide the same full range of services, with both
entering into the same contract or joint venture with the
customer.
Independent subcontractor alliances (ISAs) differ from Limited
Joint Partners (LJPs) in that a ISA is not a direct competitor of
STP. Rather, the ISA is a company that offers a subset of
services to STP, or contracts with STP to provide it with
necessary resources to perform the particular job at hand. For
example, an ISA may be a warehousing company that provides
only storage facilities for STP. Alternatively, an ISA may be a
company that is engaged in service and repairs for STP’s trucks
and planes, and/or provide sterilization and cleaning services
for STP’s trucks and planes upon completion of a job, where
STP had transported hazardous or toxic materials, requiring
specific types of sterilization or cleaning services for its
transport vehicles. There are other types of ISA that STP
engages and contracts with. With regard to ISAs, STP is the
only organization that will contract with its customer or who
will be identified to the customer. It will then enter into its own
separate subcontractor contract with its ISA, and the ISA is not
identified to STP’s customer. There is no definitive number of
ISAs that contract with STP. The specific ISAs used (if any)
will vary depending on the geographic location or area of the
country involved and the availability and cost of the ISA
available to service the area.
STP is also under pressure from several of its competitors in the

15. industry. The competitive market is driving STP to improve its
routes, delivery methods, fleet vehicles, and other facets of its
business to increase profits (a strategic goal) and to reduce
costs. The company realizes that its information technology
infrastructure has been neglected for some time and that many
operating locations are running on outdated hardware and
software. On several occasions last year, STP suffered no less
than four network compromises through one of its LJP Internet
sites that led to the disclosure of sensitive and strategic
information on contracts and mergers.
The chief information officer (CIO) made a strategic
presentation to the board of directors and executive management
to first assess the aging infrastructure and then, develop a
multi-year phased approach to have all sites (except for LJP and
ISA) on the same hardware and software platforms.
Information about the assessment indicates that the current state
core infrastructure (switches, routers, firewalls, servers, and so
on) must be capable of withstanding 10-15% growth every year
for the next seven years with a three-to-four-year phased
technology refresh cycle.
There is a hodgepodge of servers, switches, routers, and internal
hardware firewalls. Nearly all of the infrastructure is woefully
out-of-date in terms of patches and upgrades. This operational
neglect has unduly increased the risk to the network, in terms of
confidentiality, integrity, and availability. Since this will be a
multi-year technology upgrade project, something must be done
to reduce
STP’s exposure to vulnerabilities to increase the overall
security profile and reduce the risk profile.
Now that the funding has been approved for the infrastructure
assessment, the CIO has decided that it might be a good idea to
implement an Information Governance Program into the
organization, assuming he can sell the corporation on its
benefits. To that end, the CIO has hired you as IG Project
Manager to assist in initial preparatory stages.
STP Job Roles: In addition to the CIO, below is a list of

16. individuals at STP to whom you have been introduced. The CIO
has informed you that you can call upon any or all of the
individuals who hold these job roles/titles for assistance and
may name any of them to be on your project team. You may also
call upon any of the heads of the various business units for
assistance, as well as a designated contact person for each of
STP’s LJPs and ISAs.
Chief Executive Officer (CEO)*
VP of Human Resources
-house Counsel
-house Financial Analyst and Risk Manager
Overland Transport Manager
ansport Manager
* This individual is also a member of STP’s Board of Directors
INSTRUCTIONS: While it should go without stating,
information related to each of STP’s customers and the products
that you are transporting for them is highly sensitive, and in
some cases top secret. You want to make sure that any IG
Program that STP ultimately implements will allow STP to
retain all of the information about its customers, the product
transported, and the particular haul that it is required to keep

17. pursuant to federal and state law. You want to insure STP that
the proper information will be retained that it might need for
purposes of litigation and e-discovery. At the same time, you
don’t want STP to keep unnecessary information for extended
periods of time, thereby increasing the cost and time involved
with processing and retention.
1. First, select and list 10 individuals to serve on your IG
project team. Explain why you selected the team members that
you did.
2. Conduct the necessary research for each of STP’s state of
home office (Kentucky), and for the state of each of its primary
hubs (Texas and California), that will allow you to (a) educate
yourself and your team members on the mandatory information
retention requirements and privacy consideration for each of the
three states, and (b) be able to intelligently discuss the legal and
regulatory requirements with in-house counsel. You will want to
conduct internet research on this and may also want to review
Appendix B in your text book. Do not ignore this area of the
project.
3. Ultimately, your team will be required to create a “risk
profile” and risk analysis, that will describe the set of risks
facing STP in achieving its business objectives while protecting
its information and that of its customers, LJPs and ISAs, and
which will allow STP to assess the likelihood these risks hold
and their potential impact, if materialized, and in addition will
permit STP to identify risk mitigating factors to be
implemented. You need to brainstorm in order to present the
information to your team members that will facilitate the
creation of a risk profile and analysis. To that end, create a top-
10 list of the greatest risks to information that STP will face,
ranking your list in order from highest or greatest risk to
lowest, for each risk identified, state whether you believe the
risk could be assumed, transferred or mitigated in full or in
part. Also, for each risk identified identify the individual, title

18. or business unit that the team member will want to contact in
order to obtain
additional information about the fundamental activity that will
assist your team in fully completing the risk profile and
analysis.
This phase (phase I) of your project should be completed in a
WORD format. Use 1 inch margins on each page.