Assignment 1: A Conceptual Model of Architecture

Network Design for G5 Health Care

Kaitlin Perkins

Michael Soto

Nicholas Wicker

Program of Cyber Security Operations & Leadership, University of San Diego

CSOL 520-03-SU22: Secure Systems Architecture

Dr. William Hess

May 16, 2022

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Table of Contents

Overview.........................................................................................................................................2

Discussion........................................................................................................................................3

Purpose............................................................................................................................................4

Entities............................................................................................................................................5

System.....................................................................................................................................................5
Stakeholders...........................................................................................................................................5
Environment..........................................................................................................................................6
System Concerns....................................................................................................................................6
Distributed Architecture Description...................................................................................................7
Architecture...........................................................................................................................................7
Management Directive..........................................................................................................................7
Compliance Certification and Accreditation.......................................................................................8
HIPAA.................................................................................................................................................8
PCI-DSS..............................................................................................................................................8
Quality Control......................................................................................................................................8
Diagram........................................................................................................................................10
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........................................................................................................................................................12

References.....................................................................................................................................13

Overview
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G5 Health Care (G5HC) is currently seeking a software development design for their new

facility. The complexity includes an enterprise software solution that will consider software

distribution, scalability, fault tolerance, and compatibility with the deployment of connected

devices, such as the Internet of Things (IoT). Since G5HC operates in the healthcare sector, data

that traverses must follow strict standards and guidelines such as the Health Insurance Portability

and Accountability Act (HIPAA). G5HC will also allow users to pay for the health services that

they receive for fees such as their co-payments, which also requires that we follow strict

standards as required by the Payment Card Industry Data Security Standard (PCI-DSS).

Therefore, network access, which includes IoT, must identify, for example, the need for secure

availability, accessibility, and encryption, which are just a few of the challenges as part of the

defense-in-depth design.

Discussion

As healthcare moves out of the hospital and into the communities, data needs to be stored

around the patient. Current systems, which were built for institutions, store data in proprietary

formats. This creates silos, preventing data fluidity and making the routine use of data difficult

(Gornick, 2021). As one of the emerging strategic information technologies, cloud computing is

promising due to its cost efficiency and its potential to provide quality information services in

the healthcare industry. Cloud computing features three main types of service: Infrastructure-as-

a-Service (IaaS), which uses virtualization technology; Platform-as-a-Service (PaaS), which

includes an OS, development tools, and runtime tools; and Software-as-a-Service (SaaS), which

provides software applications and data.

SaaS would be the ideal architecture as this allows cloud providers to install, manage, and

operate software applications, leading to lower operation costs and high provisioning to the end
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user. There are various aspects of cloud-based medical healthcare systems, such as infrastructure

and dynamic scalability, information sharing, availability, and cloud monitoring tools (Oh, Cha,

Ji, Kang, Kim, Heo, Han, Kang, Chae, Hwang, & Yoo, 2015). When using cloud-based

resources, network managers need to understand which controls and measures are accountable to

both the cloud vendor and the organization utilizing the services.

The scope of the design is to allow both healthcare providers and their staff to connect

with their clients remotely and around the clock for support. Additionally, clients should be able

to access their information and records from a secure database from multiple form factors. The

system boundaries need to include both physical and logical access parameters such as two-

factor authentication, which will challenge user credentials and verify permissions. Healthcare

resources are vulnerable to attacks due to the sensitivity of personal information making them an

attractive target for malicious threat actors.

Purpose

Healthcare relies on health information systems (HISs) to support various care processes

and receive reimbursement for the care provided. Unfortunately, current HISs still has some

drawbacks. For example, studies on HISs reported problems with poor interface design, poor

security, missing features, lack of professional support, limited use, and low data quality. Most

of these problems occur when relevant standards, procedures, and guidelines are not followed

effectively (Tummers, Tobi, Catal, & Tekinerdogan, 2021). Our system will provide a product

that can improve on these known issues and deliver improved service to healthcare providers and

patients.
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Entities

System

This proposed health information system provides an opportunity for healthcare providers

to make personal health information more accessible to their patients in a secure way. This

would allow healthcare providers to upload health records, lab results, or any other information

relating to their patient’s healthcare. Through this system or application, patients can also access

their personal health information, schedule appointments, and even pay for their healthcare

services.

Stakeholders

There are various stakeholders invested in the development and eventual launch of the

proposed system. The three categories we have divided our stakeholders into are Executive,

Primary, and Secondary.

Executive stakeholders include the chief executive officer (CEO), chief financial officer

(CFO), chief operations officer (COO), and chief information officer (CIO). Executive

stakeholders prioritize that the overall software development is aligned with the enterprise’s

vision and legal requirements. The service that the enterprise will be providing must operate well

within budget and have a worthwhile return on investment (ROI), where operations run

smoothly, and secure information systems are properly implemented.

Primary stakeholders consist of healthcare providers and their staff, which include

doctors, nurses, and medical technicians. These members require privileged access to the system

to perform daily operations such as logging patients’ medical records, communicating with

outside network entities, access medical tools and devices during patient visits. We consider
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these features for primary stakeholders because of the permissions granted that allow them to

create and modify health records for patients.

Secondary stakeholders include members of the medical community, such as insurance

companies, pharmacists, laboratories, caregivers, and patients. These stakeholders require access

to information stored on the system to fill prescriptions, exchange patient information for

referrals, send and receive information to specialized medical centers or labs to run diagnostics,

make appointments, and obtain medical records.

Environment

This system will be operating within medical, technical, legal, and regulatory

environments. The information being stored and transmitted across this system is sensitive due to

being associated with the healthcare industry. The importance of confidentiality, integrity, and

availability of protected health information (PHI) are critical to the security of patient data, so the

system must adhere to the appropriate legal and regulatory standards.

System Concerns

The core concerns associated with our system include functionality, structure, cost,

supportability, and interoperability.

 Functionality: will the system meet the requirements established at the contextual

security architecture layer?

 Structure: will the system comply with HIPAA and PCI-DSS standards and ensure

confidentiality, integrity, and availability of sensitive information?

 Cost: what will the system cost and what will the associated costs with training,

operating, maintaining, and updating be?

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 Supportability: what is the expected learning curve to use the system, will there be

regular security updates available for the system?

 Interoperability: will the system operate among all stakeholders, between the physical

and virtual environments?

Distributed Architecture Description

The network will deploy various system components that all communicate with each

other but are also able to function on their own. In this design, there is a centralized network

controller that communicates both internally and externally with devices outside of the network

boundary. This distributed network architecture offers scalability and reliability. Components on

the distributed network can differ in size, and some could have a high volume of devices

attached to the network while some might communicate with a limited set.

Architecture

According to ISO/IEC/IEEE 42010:2011, architecture is defined as “fundamental

concepts or properties of a system in its environment embodied in its elements, relationships, and

in the principles of its design and evolution” (ISO, 2017). Our proposed system can be defined as

a distributed system, due to multiple users accessing health information stored on it from a

variety of locations and devices. Each user will only be authorized access to their data using this

distributed system.

Management Directive

Management directives are established policies, requirements, and responsibilities to

ensure that the system is fulfilling its purpose in a safe, secure, effective, and efficient manner.

These management directives are implemented to comply with privacy laws, security standards,
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and technology requirements. G5HC Information Technology Management will be responsible

for ensuring our system follows all federal and local regulations.

Compliance Certification and Accreditation

HIPAA
Per the HIPAA Security Rule, the proposed system must:

“Ensure the confidentiality, integrity, and availability of [electronically protected

health information (EPHI)] that it creates, receives, maintains, or transmits,

protect against any reasonably anticipated threats and hazards to the security or

integrity of EPHI, and protect against reasonably anticipated uses or disclosures

of such information that are not permitted by the Privacy Rule” (NIST, 2008, p.

6).

PCI-DSS
Per the PCI Security Standard (PCI DSS), the proposed system will also be

handling payment information for clients when conducting financial transactions for

healthcare services. The PCI DSS v4.0 is the current standard which is defined as, “The

PCI Data Security Standard is a global standard that provides a baseline of technical and

operational requirements designated to protect payment data. PCI DSS v4.0 is the next

evolution of the standard.” (PCI Security Standards, 2022).

Quality Control

In addition to meeting functional requirements, we also want to ensure that the proposed

software development is satisfying quality requirements. We will assess the quality by

implementing the quality-in-use model and the product quality model defined in ISO/IEC

25010:2011. According to ISO/IEC 25010:2011, “quality in use is the degree to which a product
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or system can be used by specific users to meet their needs to achieve specific goals” and uses

effectiveness, efficiency, freedom from risk, and satisfaction as the measured metrics, as seen in

Figure 1 (ISO, 2017). The product quality model uses eight characteristics to categorize the

product quality, as seen in Figure 2 (ISO, 2017).

Figure 1

Quality in Use Model

Figure 1. Effectiveness, efficiency, satisfaction, freedom from risk and context coverage are the five

properties used to describe the quality in use. Adapted from “Systems and software engineering —

Systems and software Quality Requirements and Evaluation (SQuaRE) — System and software quality

models,” by ISO, 2017.

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Figure 2

Product Quality Categories

Figure 2. Categories are used in the product quality model to characterize the quality of products.

Adapted from “Systems and software engineering — Systems and software Quality Requirements and

Evaluation (SQuaRE) — System and software quality models,” by ISO, 2017.

Diagram

Below in Figure 3, we have included a UML class diagram for our system architecture

design. As part of this section, there is an assumption that the reader understands how to read

UML diagrams and understands the basic relationships depicted on a UML diagram. The

previous section defined each entity, and the diagram shows the relationships between them as
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noted above the relationship lines and with the arrows depicting the direction. For simplicity, the

names of each entity are listed, and the previous section includes the details for each entity. The

diagram is best understood if read starting with the stakeholders on the left and continuing to the

right.

The Stakeholders have an interest in the system, and the purpose pertains to the system

concerns which addresses the interests that stakeholders have in the system. Quality control is

based on the system once it is created, and it is in an environment. The system exhibits the

architecture, and the management directives ensure that compliance certification and

accreditation are properly implemented in the architecture it is governed by compliance. The

architecture description expresses the architecture, and as mentioned in the previous section, the

architecture is based on a distributed system.

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Figure 3

G5 Healthcare UML Class Diagram

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References

Gornik, T. (2021, March 4). Re-thinking the Architecture of Healthcare IT. Retrieved May 11,

2022, from https://thejournalofmhealth.com/re-thinking-the-architecture-of-healthcare-it/

ISO. (2017). Systems and software engineering — Architecture description (ISO/IEC/IEEE

42010:2011). Retrieved from https://www.iso.org/obp/ui/#iso:std:iso-iec-ieee:42010:ed-

1:v1:en

ISO. (2017). Systems and software engineering — Systems and software Quality Requirements

and Evaluation (SQuaRE) — System and software quality models (ISO/IEC

25010:2011). Retrieved from https://www.iso.org/obp/ui/#iso:std:iso-iec:25010:ed-

1:v1:en

NIST. (2008). An Introductory Resource Guide for Implementing the Health Insurance

Portability and Accountability Act (HIPAA) Security Rule. Special Publication (NIST SP)

- 800-66 Rev 1. https://nvlpubs.nist.gov/nistpubs/Legacy/SP/nistspecialpublication800-

66r1.pdf

Oh, S., Cha, J., Ji, M., Kang, H., Kim, S., Heo, E., Han, J. S., Kang, H., Chae, H., Hwang, H., &

Yoo, S. (2015, April). Architecture Design of Healthcare Software-as-a-Service Platform

for Cloud-Based Clinical Decision Support Service. Retrieved May 11, 2022, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434058/

PCI Security Standards Council®. (2022, March). Official PCI Security Standards Council Site -

Verify PCI compliance, Download Data Security, and credit card security standards. PCI

Security Standards Council®. Retrieved May 15, 2022, from

https://www.pcisecuritystandards.org/documents/PCI-DSS-v4-0-At-A-Glance.pdf?

agreement=true&time=1652651200036
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Tummers, J., Tobi, H., Catal, C., Tekinerdogan, B. (2021). Designing a reference architecture

for health information systems. Retrieved from

https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-021-01570-