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Running head: RA WORKING AHEAD 1
RA WORKING AHEAD 8
RA Working Ahead
Sherry L. Crowe
Dr. Christopher Cronin
Interviewing & Interrogation: History & Techniques
FP6906
January 22, 2017
PART 1: PLANNING
Purpose of Specialized Interview
There are several purposes of the specialized interview
that can be used on Bob. The first one is to obtain information
from Bob to prepare him positively in the work place. The
second purpose is to identify professional strengths and
weaknesses that he may have. The third purpose is to obtain
necessary interviewing background with Bob to obtain
visibility. The fourth purpose is meant to conduct the interview
to obtain critical feedback from Bob on job search goals. The
fifth purpose is meant to build confidence and trust between
Bob and the interviewer to reduce anxiety about being
interviewed. The sixth purpose is to explore his career and
clarify his career goals. The final purpose of the specialized
interview is to assess the whole scope of the threat on Bob’s
case.
Planning the Assessment
In the process of planning the assessment, I would have to
consider Bob’s rights with confidentiality, legal and civil rights.
I would focus on his behavior and his way of thinking as
indicators of any signs towards a threat. This would be done to
avoid profiling and basing his assumptions on his characteristic
of being socio-psychological. One important factor to focus on
is the alleged threats and strange actions by Bob that a manager
received an anonymous e-mail about. I would have to gather all
his employment records and archival information to obtain any
psycho-social stressors that he may have had or has. Psycho-
social stressors can stem from issues with his family, financial
issues, records from the police, and mental health or social
records. Another factor in planning the assessment would be to
review some of the incidents reported on Bob earlier and
materials acting as indicators showing patterns of threat
behaviors. The final part of the assessment would be to pay
close attention to his potential motives, capacities and
intentions with regards to threat related behaviors and how he
copes during stressful situations.
Whom to Interview and Why
The individuals that I would interview would be the
manager that received the anonymous e-mail. The reason is
because he was the one that received that e-mail. I would see if
he or she could possibly know more. Another individual that I
would interview would be Bob’s department head because they
are the ones that work more closely with him and would or
should notice things about Bob. Bob would be the important
individual to interview since he is the one that is under scrutiny
through the company. I would also want to talk to his co-
workers at the company to get an idea of his behavior at the
workplace and what they think of Bob too.
Some other practices that can be used during the interview
with Bob is to investigate and assess the risks or threats posed
under undefined circumstances by Bob. I would also acquire all
resources and necessary consultations for a comprehensive
interview.
Nature and Purpose of Evaluation and Potential Consequences
I would inform Bob that the nature and purpose of the
evaluation is to identify the risks facing the company, an
analysis of threats, and the risks noted that have emerged as him
being the key suspect. I would also inform him that after
identifying the threat that was allegedly caused by him to the
company that there is an alternative of finding measures and
controls of managing the situation.
Some of the potential consequences of the evaluation is
that the company may face service unavailability if Bob is
arraigned in court. The absence of an employee leads to a
reduced service production or at some point a no service
provision. The company may also endure a loss in the market
and loss in profit margin if Bob is punished by the courts.
As an employee of the company his actions can lead to
decrease in competitiveness with other companies since he
might create a fret feeling with the other employees lives.
Advantages and Disadvantages of a Telephone Interview
Advantages:
They are more cost and time effective, can be completed
quickly, reach a wide geographic area, can cull weaker
candidates earlier on, and can assess the candidates telephone
manner.
Disadvantages:
They could be interrupted by many factors like other calls
(call waiting), a bad signal, and/or background noise. “You are
not able to see a person’s body language. You may have to
reschedule the interview outside of their working hours. The
final thing is that it is difficult to build as much rapport via the
telephone” (Hughes, 2015).
Assessment Instruments
One assessment instrument that I would use would be the
“Personality Assessment Inventory (PAI),” which is a self-
report 344-item personality test that assesses an individual’s
psychopathology and personality. By using this assessment, I
would get a better understanding on Bob’s personality. Another
assessment that I would use on Bob is the “Historical Clinical
Risk Management-20V3” since it is “a comprehensive set of
professional guidelines for the assessment and management of
violent risk” (Douglas et al, 2013). One last assessment that I
may use is the “Employee Risk Assessment (ERA-20),” because
this one is “designed specifically to evaluate an individual
worker’s risk for engaging in violence in the workplace”
(Bloom et al, 2017).
Evaluating Truthfulness
One way to evaluate if Bob is being truthful is by looking
for behavioral cues. Another way is by way of verbal and
nonverbal leakage. “In examining such important nonverbal
behaviors as gestures, voice, and verbal style, officers first must
focus on the facial expressions of emotion, especially those
known as micro- and subtle expressions, because these both are
involuntary and have demonstrated association with deception”
(Matsumoto et al, 2011).
Methods to use to deal with Bob’s Defensive Posture in
Interview
One method is to build trust or rapport with Bob to make
him feel at ease. Always keep in mind that you would have to
figure out whether an individual is offended or uncomfortable to
determine why they are taking that defensive posture in the first
place. In this scenario, Bob takes the defensive posture because
he may feel like he is being accused right off hand. Another
reason may be because he feels threatened. Another method to
use then would be to understand why he would feel this way.
By asking the same question but wording it differently is
another method that can be used. One last method is by
distancing the nearby authority to help Bob understand the
benefits of being honest while cooperating and letting him know
the result to save time and effort.
PART II: CLIENT STATEMENT
Here are a few questions that could be asked in a Risk or
Threat Assessment Questionnaire:
“Is the subject troubling or troubled? Has the individual
exhibited this behavior in the past or is it new? In the case of
an employee, does the organization wish to terminate or keep
the subject? As a first assessment, does the individual resemble
an emotional threatener (less likely to act) or an unemotional
one (more prone to strike)” (Albrecht, 2010)?
Risk or threat assessments are used by psychologists to
consider a spectrum of threats like natural, criminal, accidental,
and/or terrorist threats for a given location and facility.
Risk assessment should be used by psychologists in
examining supporting information evaluating the likelihood of
each threat occurrence (Renfroe et al, 2016).
Psychologists can use various instruments in conducting a
threat or risk assessment. Before using any type of assessment
instrument, it is better to know and review the kinds of
instruments present for usage and realizing the fundamental
assessment principles thus considered as the chief cornerstones
of a good assessment (Types of Assessment Instrument, n.d.).
One use of instruments used in a risk or threat assessment
by psychologists is the use of question papers which is taken
under conditions that are controllable. The use of question
papers for a threat assessment acts as a confidential purpose and
they are used in sampling knowledge and skills in the individual
(Miller, 2014).
References
Albrecht, S., D.B.A. (2010, February 01). Threat Assessment
Teams: Workplace and School Violence Prevention. Retrieved
January 31, 2018, from https://leb.fbi.gov/articles/featured-
articles/threat-assessment-teams-workplace-and-school-
violence-prevention
Bloom, H., MD, Webster, C. D., PhD, & Eisen, R. S., MSW.
(2017). ERA-20. Retrieved January 31, 2018, from
http://www.workplace.calm.to/products_services/books_guides/
workplace-violence-and-behaviour/era-20/
Douglas, K. S., Hart, S. D., Webster, C. D., & Belfrage, H.
(2013). HCR-20V3: Assessing risk of violence – User guide.
Burnaby, Canada: Mental Health, Law, and Policy Institute,
Simon Fraser University.
G. Warren, E. Schertler, and P. Bull, “Detecting Deception from
Emotional and Unemotional Cues,” Journal of Nonverbal
Behavior 33 (2009): 59-69.
Hughes, A. (2015, September 22). The 6 Different Types of
Interview (And Their Pros and Cons). Retrieved January 31,
2018, from https://www.coburgbanks.co.uk/blog/assessing-
applicants/6-different-types-of-interview/
Matsumoto, D., PhD, Hwang, H. S., PhD, Skinner, L., J.D., &
Frank, M., PhD. (2011, June 01). Evaluating Truthfulness and
Detecting Deception. Retrieved January 31, 2018, from
https://leb.fbi.gov/articles/featured-articles/evaluating-
truthfulness-and-detecting-deception
Miller, A. (2014). Threat Assessment in Action. PsycEXTRA
Dataset,45(2), 37. doi:10.1037/e501432014-006
M.G. Frank and P. Ekman, “The Ability to Detect Deceit
Generalizes Across Different Types of High-Stake
Lies,” Journal of Personality and Social Psychology 72 (1997):
1429-1439
Renfroe, N. A., PSP, & Smith, J. L., PSP. (2016, August 08).
Threat / Vulnerability Assessments and Risk Analysis.
Retrieved January 31, 2018, from
https://wbdg.org/resources/threat-vulnerability-assessments-
and-risk-analysis
Types of Assessment Instrument. (n.d.). Retrieved January 31,
2018, from
https://www.sqaacademy.org.uk/mod/book/view.php?id=10651&
chapterid=5489
C9-1
CASE STUDY 9
ST. LUKE'S HEALTH CARE SYSTEM
Hospitals have been some of the earliest adopters of wireless
local area
networks (WLANs). The clinician user population is typically
mobile and
spread out across a number of buildings, with a need to enter
and access
data in real time. St. Luke's Episcopal Health System in
Houston, Texas
(www.stlukestexas.com) is a good example of a hospital that
has made
effective use wireless technologies to streamline clinical work
processes.
Their wireless network is distributed throughout several
hospital buildings
and is used in many different applications. The majority of the
St. Luke’s
staff uses wireless devices to access data in real-time, 24 hours
a day.
Examples include the following:
• Diagnosing patients and charting their progress: Doctors and
nurses use wireless laptops and tablet PCs to track and chart
patient
care data.
• Prescriptions: Medications are dispensed from a cart that is
wheeled
from room to room. Clinician uses a wireless scanner to scan
the
patient's ID bracelet. If a prescription order has been changed or
cancelled, the clinician will know immediately because the
mobile device
displays current patient data.
http://www.stlukestexas.com/
C9-2
• Critical care units: These areas use the WLAN because
running hard
wires would mean moving ceiling panels. The dust and microbes
that
such work stirs up would pose a threat to patients.
• Case management: The case managers in the Utilization
Management
Department use the WLAN to document patient reviews,
insurance
calls/authorization information, and denial information. The
wireless
session enables real time access to information that ensures the
correct
level of care for a patient and/or timely discharge.
• Blood management: Blood management is a complex process
that
involves monitoring both patients and blood products during all
stages of
a treatment process. To ensure that blood products and patients
are
matched correctly, St. Luke’s uses a wireless bar code scanning
process
that involves scanning both patient and blood product bar codes
during
the infusion process. This enables clinicians to confirm patient
and blood
product identification before proceeding with treatment.
• Nutrition and diet: Dietary service representatives collect
patient
menus at each nursing unit and enter them as they go. This
allows more
menus to be submitted before the cutoff time, giving more
patients
more choice. The dietitian can also see current patient
information, such
as supplement or tube feeding data, and view what the patient
actually
received for a certain meal.
• Mobile x-ray and neurologic units: St. Luke’s has
implemented the
wireless network infrastructure necessary to enable doctors and
clinicians to use mobile x-ray and neurologic scanning units.
This makes
it possible to take x-rays or to perform neurological studies in
patient
rooms. This minimizes the need to schedule patients for
neurology or
radiology lab visits. The mobile units also enable equipment to
be
brought to the bedside of patients that cannot be easily moved.
The
wireless neurology and x-ray units have also helped to reduce
the time
between diagnosis and the beginning patient care.
C9-3
Original WLAN
St. Luke's first WLAN was deployed in January 1998 and made
the hospital
an early pioneer in wireless health care applications. St. Luke’s
first wireless
LAN was implemented in a single building using access points
(APs) made by
Proxim (www.proxim.com).
A principal goal of this initial installation was to improve
efficiency.
However, sometimes the WLAN had the opposite effect. The
main problem
was dropped connections. As a user moved about the building,
there was a
tendency for the WLAN to drop the connection rather than
performing the
desired handoff to another access point. As a result, a user had
to
reestablish the connection, log into the application again, and
reenter
whatever data might have been lost.
There were physical problems as well. The walls in part of the
building
were constructed around chicken wire, which interfered with
radio waves.
Some patients' rooms were located in pockets with weak radio
signals. For
these rooms, a nurse or doctor would sometimes lose a
connection and have
to step out into the hallway to reconnect. Microwave ovens in
the
kitchenettes on each floor were also a source of interference.
Finally, as more users were added to the system, the Proxim
APs, with a
capacity of 1.2 Mbps, became increasingly inadequate, causing
ongoing
performance issues.
Enhanced LAN
To overcome the problems with their original WLAN and reap
the potential
benefits listed earlier in this case study, St. Luke's made two
changes
[CONR03, NETM03]. First, the hospital phased out the Proxim
APs and
replaced them with Cisco Aironet (www.cisco.com) APs. The
Cisco APs, using
IEEE 802.11b, operated at 11 Mbps. Also, the Cisco APs used
direct
C9-4
sequence spread spectrum (DSSS), which is more reliable than
the
frequency-hopping technique used in the Proxim APs.
The second measure taken by St Luke's was to acquire a
software
solution from NetMotion Wireless (netmotionwireless.com)
called Mobility.
The basic layout of the Mobility solution is shown in Figure
C9.1. Mobility
software is installed in each wireless client device (typically a
laptop,
handheld, or tablet PC) and in two NetMotion servers whose
task is to
maintain connections. The two servers provide a backup
capability in case
C9-5
one server fails. The Mobility software maintains the state of an
application
even if a wireless device moves out of range, experiences
interference, or
switches to standby mode. When a user comes back into range
or switches
into active mode, the user's application resumes where it left
off.
In essence, Mobility works as follows: Upon connecting, each
Mobility
client is assigned a virtual IP address by the Mobility server on
the wired
network. The Mobility server manages network traffic on behalf
of the client,
intercepting packets destined for the client's virtual address and
forwarding
them to the client's current POP (point of presence) address.
While the POP
address may change when the device moves to a different
subnet, from one
coverage area to another, or even from one network to another,
the virtual
address remains constant while any connections are active.
Thus, the
Mobility server is a proxy device inserted between a client
device and an
application server.
Enhancing WLAN Security
In 2007, St. Luke’s upgraded to Mobility XE mobile VPN
solution [NETM07].
This migration was undertaken to enhance security and
compliance with
HIPPA data transmission and privacy requirements. Mobility
XE server
software was deployed in the IT department’s data center and
client
software was installed on laptops, handheld devices, and tablet
PCs.
With Mobility XE running on both clients and servers, all
transmitted
data passed between them is encrypted using AES (Advanced
Encryption
Standard) 128-bit encryption. Mobility XE also serves as an
additional
firewall; devices that are not recognized by the Mobility XE
server are not
allowed to access the network. This arrangement helped St.
Luke’s achieve
its IT goal of having encryption for all wireless data
communications.
Mobility XE also enables the IT department to centrally
manage all
wireless devices used by clinicians. This allows them to monitor
the
C9-6
applications currently being used by any device or user, the
amount of data
being transmitted, and even the remaining battery life of the
wireless device.
If a Mobility XE device is stolen or lost, it can be immediately
quarantined by
network managers.
IT executives at St. Luke’s view wireless networking as key
lever in their
quest to increase clinician productivity and improved patient
care. Mobile
EKG units have been deployed bringing the total of wireless
devices in use to
nearly a 1,000.
Discussion Questions
1. Visit the NetMotion Web site (www.netmotionwireless.com)
and access
and read other Mobility XE success stories. Discuss the patterns
that
can be observed in the benefits that Mobility XE users have
realized via
its deployment and use.
2. Do some Internet research on the security implications of
HIPPA
requirements for hospital networks. Discuss the major types of
security mechanisms that must be in place to ensure hospital
compliance with HIPPA requirements.
3. Do some Internet research on the use of VLANs in hospitals.
Summarize the benefits of using VLANs in hospitals and
identify
examples of how St. Luke’s could further enhance its wireless
network
by implementing VLANs.
Sources
[CONR03] Conery-Murray, A. “Hospital Cures Wireless LAN
of Dropped
Connections.” Network Magazine, January 2003.
[NETM03] Netmotion Wireless, Inc. “NetMotion Mobility:
Curing the
Wireless LAN at St. Luke’s Episcopal Hospital. Case Study,
2003.
Netmotionwireless.com/resources/case_studies.aspx.
[NETM07] Netmotion Wireless, Inc. “St. Luke’s Episcopal
Health System: A
Case Study in Healthcare Productivity.” 2007. Retrieved online
at:
http://www.netmotionwireless.com/st-lukes-case-study.aspx
http://www.netmotionwireless.com/
http://www.netmotionwireless.com/st-lukes-case-
study.aspxCASE STUDY 9Original WLANEnhanced
LANEnhancing WLAN SecurityDiscussion QuestionsSources

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Running head RA WORKING AHEAD1RA WORKING AHEAD8RA.docx

  • 1. Running head: RA WORKING AHEAD 1 RA WORKING AHEAD 8 RA Working Ahead Sherry L. Crowe Dr. Christopher Cronin Interviewing & Interrogation: History & Techniques FP6906 January 22, 2017 PART 1: PLANNING Purpose of Specialized Interview There are several purposes of the specialized interview that can be used on Bob. The first one is to obtain information from Bob to prepare him positively in the work place. The second purpose is to identify professional strengths and weaknesses that he may have. The third purpose is to obtain necessary interviewing background with Bob to obtain visibility. The fourth purpose is meant to conduct the interview
  • 2. to obtain critical feedback from Bob on job search goals. The fifth purpose is meant to build confidence and trust between Bob and the interviewer to reduce anxiety about being interviewed. The sixth purpose is to explore his career and clarify his career goals. The final purpose of the specialized interview is to assess the whole scope of the threat on Bob’s case. Planning the Assessment In the process of planning the assessment, I would have to consider Bob’s rights with confidentiality, legal and civil rights. I would focus on his behavior and his way of thinking as indicators of any signs towards a threat. This would be done to avoid profiling and basing his assumptions on his characteristic of being socio-psychological. One important factor to focus on is the alleged threats and strange actions by Bob that a manager received an anonymous e-mail about. I would have to gather all his employment records and archival information to obtain any psycho-social stressors that he may have had or has. Psycho- social stressors can stem from issues with his family, financial issues, records from the police, and mental health or social records. Another factor in planning the assessment would be to review some of the incidents reported on Bob earlier and materials acting as indicators showing patterns of threat behaviors. The final part of the assessment would be to pay close attention to his potential motives, capacities and intentions with regards to threat related behaviors and how he copes during stressful situations. Whom to Interview and Why The individuals that I would interview would be the manager that received the anonymous e-mail. The reason is because he was the one that received that e-mail. I would see if he or she could possibly know more. Another individual that I would interview would be Bob’s department head because they are the ones that work more closely with him and would or should notice things about Bob. Bob would be the important individual to interview since he is the one that is under scrutiny
  • 3. through the company. I would also want to talk to his co- workers at the company to get an idea of his behavior at the workplace and what they think of Bob too. Some other practices that can be used during the interview with Bob is to investigate and assess the risks or threats posed under undefined circumstances by Bob. I would also acquire all resources and necessary consultations for a comprehensive interview. Nature and Purpose of Evaluation and Potential Consequences I would inform Bob that the nature and purpose of the evaluation is to identify the risks facing the company, an analysis of threats, and the risks noted that have emerged as him being the key suspect. I would also inform him that after identifying the threat that was allegedly caused by him to the company that there is an alternative of finding measures and controls of managing the situation. Some of the potential consequences of the evaluation is that the company may face service unavailability if Bob is arraigned in court. The absence of an employee leads to a reduced service production or at some point a no service provision. The company may also endure a loss in the market and loss in profit margin if Bob is punished by the courts. As an employee of the company his actions can lead to decrease in competitiveness with other companies since he might create a fret feeling with the other employees lives. Advantages and Disadvantages of a Telephone Interview Advantages: They are more cost and time effective, can be completed quickly, reach a wide geographic area, can cull weaker candidates earlier on, and can assess the candidates telephone manner. Disadvantages: They could be interrupted by many factors like other calls (call waiting), a bad signal, and/or background noise. “You are not able to see a person’s body language. You may have to reschedule the interview outside of their working hours. The
  • 4. final thing is that it is difficult to build as much rapport via the telephone” (Hughes, 2015). Assessment Instruments One assessment instrument that I would use would be the “Personality Assessment Inventory (PAI),” which is a self- report 344-item personality test that assesses an individual’s psychopathology and personality. By using this assessment, I would get a better understanding on Bob’s personality. Another assessment that I would use on Bob is the “Historical Clinical Risk Management-20V3” since it is “a comprehensive set of professional guidelines for the assessment and management of violent risk” (Douglas et al, 2013). One last assessment that I may use is the “Employee Risk Assessment (ERA-20),” because this one is “designed specifically to evaluate an individual worker’s risk for engaging in violence in the workplace” (Bloom et al, 2017). Evaluating Truthfulness One way to evaluate if Bob is being truthful is by looking for behavioral cues. Another way is by way of verbal and nonverbal leakage. “In examining such important nonverbal behaviors as gestures, voice, and verbal style, officers first must focus on the facial expressions of emotion, especially those known as micro- and subtle expressions, because these both are involuntary and have demonstrated association with deception” (Matsumoto et al, 2011). Methods to use to deal with Bob’s Defensive Posture in Interview One method is to build trust or rapport with Bob to make him feel at ease. Always keep in mind that you would have to figure out whether an individual is offended or uncomfortable to determine why they are taking that defensive posture in the first place. In this scenario, Bob takes the defensive posture because he may feel like he is being accused right off hand. Another reason may be because he feels threatened. Another method to use then would be to understand why he would feel this way.
  • 5. By asking the same question but wording it differently is another method that can be used. One last method is by distancing the nearby authority to help Bob understand the benefits of being honest while cooperating and letting him know the result to save time and effort. PART II: CLIENT STATEMENT Here are a few questions that could be asked in a Risk or Threat Assessment Questionnaire: “Is the subject troubling or troubled? Has the individual exhibited this behavior in the past or is it new? In the case of an employee, does the organization wish to terminate or keep the subject? As a first assessment, does the individual resemble an emotional threatener (less likely to act) or an unemotional one (more prone to strike)” (Albrecht, 2010)? Risk or threat assessments are used by psychologists to consider a spectrum of threats like natural, criminal, accidental, and/or terrorist threats for a given location and facility. Risk assessment should be used by psychologists in examining supporting information evaluating the likelihood of each threat occurrence (Renfroe et al, 2016). Psychologists can use various instruments in conducting a threat or risk assessment. Before using any type of assessment instrument, it is better to know and review the kinds of instruments present for usage and realizing the fundamental assessment principles thus considered as the chief cornerstones of a good assessment (Types of Assessment Instrument, n.d.). One use of instruments used in a risk or threat assessment by psychologists is the use of question papers which is taken under conditions that are controllable. The use of question papers for a threat assessment acts as a confidential purpose and they are used in sampling knowledge and skills in the individual (Miller, 2014).
  • 6. References Albrecht, S., D.B.A. (2010, February 01). Threat Assessment Teams: Workplace and School Violence Prevention. Retrieved January 31, 2018, from https://leb.fbi.gov/articles/featured- articles/threat-assessment-teams-workplace-and-school- violence-prevention Bloom, H., MD, Webster, C. D., PhD, & Eisen, R. S., MSW. (2017). ERA-20. Retrieved January 31, 2018, from http://www.workplace.calm.to/products_services/books_guides/ workplace-violence-and-behaviour/era-20/ Douglas, K. S., Hart, S. D., Webster, C. D., & Belfrage, H. (2013). HCR-20V3: Assessing risk of violence – User guide. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University. G. Warren, E. Schertler, and P. Bull, “Detecting Deception from Emotional and Unemotional Cues,” Journal of Nonverbal Behavior 33 (2009): 59-69. Hughes, A. (2015, September 22). The 6 Different Types of Interview (And Their Pros and Cons). Retrieved January 31, 2018, from https://www.coburgbanks.co.uk/blog/assessing- applicants/6-different-types-of-interview/ Matsumoto, D., PhD, Hwang, H. S., PhD, Skinner, L., J.D., & Frank, M., PhD. (2011, June 01). Evaluating Truthfulness and Detecting Deception. Retrieved January 31, 2018, from https://leb.fbi.gov/articles/featured-articles/evaluating- truthfulness-and-detecting-deception Miller, A. (2014). Threat Assessment in Action. PsycEXTRA Dataset,45(2), 37. doi:10.1037/e501432014-006 M.G. Frank and P. Ekman, “The Ability to Detect Deceit Generalizes Across Different Types of High-Stake
  • 7. Lies,” Journal of Personality and Social Psychology 72 (1997): 1429-1439 Renfroe, N. A., PSP, & Smith, J. L., PSP. (2016, August 08). Threat / Vulnerability Assessments and Risk Analysis. Retrieved January 31, 2018, from https://wbdg.org/resources/threat-vulnerability-assessments- and-risk-analysis Types of Assessment Instrument. (n.d.). Retrieved January 31, 2018, from https://www.sqaacademy.org.uk/mod/book/view.php?id=10651& chapterid=5489 C9-1 CASE STUDY 9 ST. LUKE'S HEALTH CARE SYSTEM Hospitals have been some of the earliest adopters of wireless local area networks (WLANs). The clinician user population is typically mobile and spread out across a number of buildings, with a need to enter and access data in real time. St. Luke's Episcopal Health System in Houston, Texas
  • 8. (www.stlukestexas.com) is a good example of a hospital that has made effective use wireless technologies to streamline clinical work processes. Their wireless network is distributed throughout several hospital buildings and is used in many different applications. The majority of the St. Luke’s staff uses wireless devices to access data in real-time, 24 hours a day. Examples include the following: • Diagnosing patients and charting their progress: Doctors and nurses use wireless laptops and tablet PCs to track and chart patient care data. • Prescriptions: Medications are dispensed from a cart that is wheeled from room to room. Clinician uses a wireless scanner to scan the patient's ID bracelet. If a prescription order has been changed or cancelled, the clinician will know immediately because the mobile device
  • 9. displays current patient data. http://www.stlukestexas.com/ C9-2 • Critical care units: These areas use the WLAN because running hard wires would mean moving ceiling panels. The dust and microbes that such work stirs up would pose a threat to patients. • Case management: The case managers in the Utilization Management Department use the WLAN to document patient reviews, insurance calls/authorization information, and denial information. The wireless session enables real time access to information that ensures the correct level of care for a patient and/or timely discharge. • Blood management: Blood management is a complex process that involves monitoring both patients and blood products during all stages of a treatment process. To ensure that blood products and patients
  • 10. are matched correctly, St. Luke’s uses a wireless bar code scanning process that involves scanning both patient and blood product bar codes during the infusion process. This enables clinicians to confirm patient and blood product identification before proceeding with treatment. • Nutrition and diet: Dietary service representatives collect patient menus at each nursing unit and enter them as they go. This allows more menus to be submitted before the cutoff time, giving more patients more choice. The dietitian can also see current patient information, such as supplement or tube feeding data, and view what the patient actually received for a certain meal. • Mobile x-ray and neurologic units: St. Luke’s has implemented the wireless network infrastructure necessary to enable doctors and clinicians to use mobile x-ray and neurologic scanning units.
  • 11. This makes it possible to take x-rays or to perform neurological studies in patient rooms. This minimizes the need to schedule patients for neurology or radiology lab visits. The mobile units also enable equipment to be brought to the bedside of patients that cannot be easily moved. The wireless neurology and x-ray units have also helped to reduce the time between diagnosis and the beginning patient care. C9-3 Original WLAN St. Luke's first WLAN was deployed in January 1998 and made the hospital an early pioneer in wireless health care applications. St. Luke’s first wireless LAN was implemented in a single building using access points (APs) made by Proxim (www.proxim.com).
  • 12. A principal goal of this initial installation was to improve efficiency. However, sometimes the WLAN had the opposite effect. The main problem was dropped connections. As a user moved about the building, there was a tendency for the WLAN to drop the connection rather than performing the desired handoff to another access point. As a result, a user had to reestablish the connection, log into the application again, and reenter whatever data might have been lost. There were physical problems as well. The walls in part of the building were constructed around chicken wire, which interfered with radio waves. Some patients' rooms were located in pockets with weak radio signals. For these rooms, a nurse or doctor would sometimes lose a connection and have to step out into the hallway to reconnect. Microwave ovens in the kitchenettes on each floor were also a source of interference.
  • 13. Finally, as more users were added to the system, the Proxim APs, with a capacity of 1.2 Mbps, became increasingly inadequate, causing ongoing performance issues. Enhanced LAN To overcome the problems with their original WLAN and reap the potential benefits listed earlier in this case study, St. Luke's made two changes [CONR03, NETM03]. First, the hospital phased out the Proxim APs and replaced them with Cisco Aironet (www.cisco.com) APs. The Cisco APs, using IEEE 802.11b, operated at 11 Mbps. Also, the Cisco APs used direct C9-4 sequence spread spectrum (DSSS), which is more reliable than the frequency-hopping technique used in the Proxim APs.
  • 14. The second measure taken by St Luke's was to acquire a software solution from NetMotion Wireless (netmotionwireless.com) called Mobility. The basic layout of the Mobility solution is shown in Figure C9.1. Mobility software is installed in each wireless client device (typically a laptop, handheld, or tablet PC) and in two NetMotion servers whose task is to maintain connections. The two servers provide a backup capability in case C9-5 one server fails. The Mobility software maintains the state of an application even if a wireless device moves out of range, experiences interference, or switches to standby mode. When a user comes back into range or switches into active mode, the user's application resumes where it left off.
  • 15. In essence, Mobility works as follows: Upon connecting, each Mobility client is assigned a virtual IP address by the Mobility server on the wired network. The Mobility server manages network traffic on behalf of the client, intercepting packets destined for the client's virtual address and forwarding them to the client's current POP (point of presence) address. While the POP address may change when the device moves to a different subnet, from one coverage area to another, or even from one network to another, the virtual address remains constant while any connections are active. Thus, the Mobility server is a proxy device inserted between a client device and an application server. Enhancing WLAN Security In 2007, St. Luke’s upgraded to Mobility XE mobile VPN solution [NETM07]. This migration was undertaken to enhance security and compliance with
  • 16. HIPPA data transmission and privacy requirements. Mobility XE server software was deployed in the IT department’s data center and client software was installed on laptops, handheld devices, and tablet PCs. With Mobility XE running on both clients and servers, all transmitted data passed between them is encrypted using AES (Advanced Encryption Standard) 128-bit encryption. Mobility XE also serves as an additional firewall; devices that are not recognized by the Mobility XE server are not allowed to access the network. This arrangement helped St. Luke’s achieve its IT goal of having encryption for all wireless data communications. Mobility XE also enables the IT department to centrally manage all wireless devices used by clinicians. This allows them to monitor the
  • 17. C9-6 applications currently being used by any device or user, the amount of data being transmitted, and even the remaining battery life of the wireless device. If a Mobility XE device is stolen or lost, it can be immediately quarantined by network managers. IT executives at St. Luke’s view wireless networking as key lever in their quest to increase clinician productivity and improved patient care. Mobile EKG units have been deployed bringing the total of wireless devices in use to nearly a 1,000. Discussion Questions 1. Visit the NetMotion Web site (www.netmotionwireless.com) and access and read other Mobility XE success stories. Discuss the patterns that can be observed in the benefits that Mobility XE users have realized via its deployment and use.
  • 18. 2. Do some Internet research on the security implications of HIPPA requirements for hospital networks. Discuss the major types of security mechanisms that must be in place to ensure hospital compliance with HIPPA requirements. 3. Do some Internet research on the use of VLANs in hospitals. Summarize the benefits of using VLANs in hospitals and identify examples of how St. Luke’s could further enhance its wireless network by implementing VLANs. Sources [CONR03] Conery-Murray, A. “Hospital Cures Wireless LAN of Dropped Connections.” Network Magazine, January 2003. [NETM03] Netmotion Wireless, Inc. “NetMotion Mobility: Curing the Wireless LAN at St. Luke’s Episcopal Hospital. Case Study, 2003. Netmotionwireless.com/resources/case_studies.aspx. [NETM07] Netmotion Wireless, Inc. “St. Luke’s Episcopal Health System: A Case Study in Healthcare Productivity.” 2007. Retrieved online at: http://www.netmotionwireless.com/st-lukes-case-study.aspx http://www.netmotionwireless.com/ http://www.netmotionwireless.com/st-lukes-case-
  • 19. study.aspxCASE STUDY 9Original WLANEnhanced LANEnhancing WLAN SecurityDiscussion QuestionsSources