Case Study: ACMC Hospital Network Upgrade

This case study analyzes the network infrastructure of Acme County Medical Center
(ACMC) Hospital, a fictitious small county hospital in the United States. This same case
study is used throughout the remainder of the book so that you can continue to evaluate
your understanding of the concepts presented.

Case Study General Instructions

Use the scenarios, information, and parameters provided at each task of the ongoing case
study. If you encounter ambiguities, make reasonable assumptions and proceed. For all
tasks, use the initial customer scenario and build on the solutions provided thus far. You
can use any and all documentation, books, white papers, and so on.

In each step, you act as a network design consultant. Make creative proposals to
accomplish the customer’s business needs. Justify your ideas when they differ from the
provided solutions. Use any design strategies you feel are appropriate. The final goal of
each case study is a paper solution.

Appendix A, “Answers to Review Questions and Case Studies,” provides a solution for
each step based on assumptions made. There is no claim that the provided solution is the
best or only solution. Your solution might be more appropriate for the assumptions you
made. The provided solution helps you understand the author’s reasoning and allows you
to compare and contrast your solution.

In this case study, you develop a high-level design for the ACMC Hospital network.

Case Study Scenario

This case study analyzes the network infrastructure of ACMC Hospital, a fictitious small
county hospital. The hospital has provided you with a short description of the current
situation and its plans. As a network designer, it is your job to identify all the
organization’s requirements and data that will allow you to provide an effective solution.

Organizational Facts

ACMC Hospital is a medium-sized regional hospital located in Acme County, with

approximately 500 staff members supporting up to 1000 patients. The hospital is
interested in updating its main facility (which uses equipment from various vendors) in
its Layer 2 campus. You are meeting to define the client’s requirements.

ACMC has 15 buildings in total on the campus, plus 5 small remote clinics. There are
two main hospital buildings and an auxiliary building. The two main buildings have
seven floors each, with four wiring closets per floor. The auxiliary building—the
Children’s Place—is connected to the two main buildings; the switches from these three
buildings are connected with fiber connections in a ring. The Children’s Place has three
floors, with three wiring closets per floor. The other 12 campus buildings are smaller
office and support facilities, with 10 to 40 people per building, located on one or two
floors.

The network architect is new to the hospital. The hospital is aggressively expanding its
clinic and alternative emergency room presence within Acme County. Due to population
growth in general, plans to enlarge the main campus are also under way. The hospital is
doing fairly well financially. It wants to selectively deploy cutting-edge technology for
better patient care and high productivity. Management is tired of network downtime and
slowness affecting patient care. Network manageability is important because ACMC has
a tradition of basing operations on small support staffs with high productivity. ACMC’s
upgrade timeframe is 6 to 12 months.

Current Situation

The current network uses inexpensive switches from several vendors, purchased over
time. They comply with various standards, depending on when they were purchased. The
switches are not SNMP-manageable, although a small amount of information is available
from each switch via the web or command-line interface.

Within each of the three main buildings is a main switch. One floor switch from each
floor connects to the main switch. The other switches connect either directly to the floor
switch or via a daisy chain of switches, depending on which was most convenient at the
time.

The small outlying buildings have one or two 24-port switches. One of these connects
back to one of the main building switches via fiber. If there is a second switch, it
connects via the first switch.

Currently, the staff VLAN spans the entire campus. No Layer 3 switching is present. The
address space is 172.16.0.0 /16. Addresses are coded sequentially into PCs as they are
deployed. Staff members have been meaning to deploy DHCP but have not had the time.

The applications that the organization is currently running include standard office
applications, plus some specialized medical tools running over IP. Radiology, Oncology,
and other departments do medical imaging. As these departments acquire new tools, they
are adding real-time motion to the highly detailed medical images, requiring large
amounts of bandwidth. All the new servers are capable of using Gigabit or Gigabit
EtherChannel connectivity.

Many servers are currently located in various closets. Many lack uninterrupted power
supplies or proper environmental controls. A staff member has to roll a tape backup cart
to each server closet to back up each server. There are about 40 centrally located servers
in one raised floor “server room,” and 30 other servers distributed around the campus
near their users. The server room takes up part of the first floor of Main Building 1, along
with the cafeteria and other non-networked areas.

Figure 2-29 ACMC Network Diagram Provided by the Customer

Hospital Support Services has been experimenting with workstations on wheels (WoW).
Moving these and plugging them into an Ethernet jack is just not working very well.
The WAN uses 56-kbps links to three of the remote clinics and dialup connectivity to the
other two. The one router uses static routing that was configured by a previous network
designer.

The staff members have frequently complained about slow response times. There appears
to be severe congestion of the LAN, especially at peak hours. The staff provided you with
a copy of its recent network diagram, which is shown in Figure 2-29.

You believe that the current situation does not provide for future growth, high reliability,
and ease of management.

Plans and Requirements

The introduction of new applications will result in an additional load on the links to the
remote clinics. The expected tighter integration and growth of remote offices will even
further increase the traffic load on the WAN links. The hospital would like to upgrade the
WAN infrastructure to provide sufficient bandwidth between the remote clinics and
headquarters and, at the same time, find a solution for better convergence during network
failures. The company is aware of the drawbacks of its current IP addressing scheme and
is seeking a better solution.

The hospital must comply with the U.S. Health Insurance Portability and Accountability
Act (HIPAA).

Case Study Questions

Complete the following steps:

Step 1

Document ACMC’s requirements.

Step 2

Document any information that you think is missing from the case study scenario and that
you consider necessary for the design.

Before beginning the design, you will need this information. Assume that you have talked
to the customer about the missing information, and document any assumptions you make.
You don’t need to assume that all the missing information is provided by the customer;
some might never be available. However, you do need to assume answers for your critical
questions.

NOTE Further information is provided in the case studies in subsequent chapters, as

relevant for that chapter. Thus, not all the information is provided in these answers.
Step 3

Outline the major design areas that you feel need to be addressed when designing the
solution for this scenario. List the tasks, and provide a brief comment for each.

NOTE There are many ways, other than those provided in our answer, in which this
customer’s network could be improved. Further information is provided in the case
studies in subsequent chapters, and other options are discussed, as relevant for that
chapter.