Question 9

Process Scheduling: Linux uses a CPU scheduler (CFS Completely Fair Scheduler by
default) to distribute CPU time among processes. During peak hours, many EHR
application threads compete for CPU time, causing context-switching overhead and
scheduling delays, slowing record retrieval.

Memory Management: Linux manages RAM using a virtual memory system with demand
paging. When applications consume more RAM than physically available, the kernel pages
out memory to swap space on disk. Disk I/O is orders of magnitude slower than RAM, so
heavy swapping degrades performance severely.

Optimization 1 CPU Pinning and Priority Tuning: Assign critical EHR application
processes higher scheduling priority using nice/renice values or real-time scheduling
classes, and pin specific processes to dedicated CPU cores to reduce contention and
context-switching.

Optimization 2 Swap Management and RAM Expansion: Reduce the kernel's

swappiness parameter (e.g., [Link]=10) to discourage premature swapping, and
configure memory limits per virtual machine to prevent any single VM from monopolizing
RAM and forcing others into swap.
Question 8
Report promptly through the institution's formal incident reporting channel (e.g., to the
Informatics Governance and Security Review Committee described in the passage),
documenting the finding with evidence such as audit logs.
Preserve evidence without tampering, ensuring logs and records remain intact for
investigation.

Escalate appropriately if internal reporting is ignored or suppressed, professional

standards may require escalation to regulatory bodies or legal authorities.

Alignment with informatics law: Reporting procedures must comply with local data
protection regulations, which typically mandate breach notification within defined
timeframes. Staff who fail to report known breaches may share legal liability.
Whistleblower protections under law generally shield staff who report in good faith,
incentivizing transparency over concealment.
Question 7
Confidentiality means patient information is accessible only to those with a legitimate,
authorized need. In an EHR, this is enforced through role-based access controls (RBAC),
encryption of stored and transmitted data, and audit logging of all access events.

Accountability means every action in the system is traceable to a specific, identifiable

individual. EHR systems enforce this through unique user credentials, detailed audit trails,
and MFA ensuring no one can deny or escape responsibility for their actions.

Informed Consent means patients are told how their data will be collected, used, and
shared, and they agree to this before treatment. In an EHR, this is enforced through
consent management modules, clear data-use policies presented to patients, and
restricting data flows to only those purposes the patient approved.
Question 6

Unauthorized record access and credential sharing breach ethical principles:

Confidentiality: Only authorized individuals should have access to patient data. This barrier
is destroyed when credentials are shared.

Informed Consent: Patients give permission for certain roles and uses of their data. The
conditions under which they gave their information are broken by unauthorized access.

Accountability: Each user must take personal responsibility for the things they do within the
system. This is not possible with shared [Link]/Fairness: To guarantee
equitable, suitable information distribution, role-based access is in place. Avoiding it
compromises the governance of a safe and equitable system.
Question 5

1. Regular Restore Testing: The passage notes backups are not consistently tested. The
hospital should implement scheduled, automated restore drills periodically restoring
backup data to a test environment to verify completeness and usability. This confirms
backups are not silently corrupted.

2. Checksums and Integrity Verification: After each nightly backup to the NAS device, a
cryptographic checksum of the backup should be generated and stored separately. Before
any restore, the checksum is recalculated and compared, instantly detecting corruption or
tampering.
Question 4

Ethically, this violates the principle of confidentiality patients have a right to expect their
records are seen only by those directly involved in their care. It also breaches
non-maleficence (risk of harm through data misuse) and professional integrity, as nursing
and informatics codes of conduct require strict data discipline.

Legally, under data protection and health informatics law , unauthorized access to patient
records constitutes a breach of patient privacy. Potential consequences include:
Civil liability for the hospital and the individual nurse
Regulatory sanctions and fines against the institution
Criminal charges if access is deemed intentional and malicious
Termination and possible loss of professional licensure
Mandatory breach notification to affected patients
Question 3

i. Unauthorized Access to Sensitive Data: When credentials are exchanged, anyone who
are not allowed to access administration modules and patient information can do so. This
exposes private Protected Health Information (PHI) to people who don't have a right to
read it, which is against the least privilege principle. Patient confidentiality issues and
possible infractions of privacy laws like HIPAA may result from this.

ii. Difficulty in Auditing and Accountability: It is impossible to ascertain who actually carried
out an action within the system due to shared credentials. The audit logs will only display
the shared account being used in the event of an unauthorized access or modification, not
the specific person in charge. This undermines the EHR system's entire accountability
framework, impedes security issue investigations, and stops disciplinary proceedings.

Loss of Accountability/Non-repudiation: It is no longer possible to accurately link actions to

a particular person using audit logs. The inability to identify the perpetrator of a detrimental
conduct carried out via a shared account compromises forensic investigation and legal
accountability. Mitigation: Even if credentials are shared, the account's rights restrict what
may be accessed since Linux-based access controls (PAM, sudo rules, file permissions,
SELinux) apply role-based restrictions at the OS level.

Because the second element is difficult to transfer, credential sharing is essentially useless
when a VPN with MFA (Multi-element Authentication) assures that logging in requires
something the user knows (password) and has (a physical token or phone).
Question 2

INetwork Infrastructure Upgrades: The network infrastructure upgrades could be explored.

This could involve improving the bandwidth of the hospital's internal network, upgrading
network switches, or optimizing the network topology. A more robust and faster network
infrastructure can reduce the time it takes for data to travel between the thin clients and
the application servers, thereby decreasing latency.

ii. Quality of Service (QoS) Configurations: The passage also mentions quality of Service
(QoS) configurations. QoS is a mechanism that prioritizes certain types of network traffic
over others. By implementing QoS, the IT team can ensure that traffic related to the EHR
system receives higher priority than less critical traffic. This means that even during peak
hours when the network is busy, EHR data packets will be processed and transmitted
more quickly, reducing latency for thin-client users accessing the EHR.
[Link] technical factors from the passage that contribute to high CPU and
memory usage on the Linux servers and how each factor affects system
performance are:

1i. Process Scheduling: The operating system's process scheduler is in charge of

assigning CPU time to different virtual machines and running apps in a virtualized
environment. CPU cycles may be allocated inefficiently if the scheduler is not set up
optimally or if there are too many demanding tasks competing for resources. This implies
that instead of actively processing tasks, processes may spend more time waiting for their
turn to execute, which causes delays and excessive CPU consumption as the system
continuously seeks to manage and reschedule these processes.

ii. Memory Swapping: When the Linux servers run out of available physical RAM, they
resort to memory swapping. This is a process where less frequently used data from RAM
is moved to a designated swap space on the hard drive. While this frees up RAM for active
processes, accessing data from a hard drive is significantly slower than accessing it from
RAM. Consequently, when the system needs to retrieve swapped-out data, it incurs a
considerable performance penalty, leading to high memory usage (as the system is
constantly managing the swap file) and slow application response times.

[Link] network latency for remote users connecting via VPN: High network latency for
remote users connecting via VPN can slow down EHR access and indirectly strain
application servers. The extra encryption and routing involved in VPN connections mean
data requests and responses take longer. This delay can make application servers seem
sluggish, as they wait for these delayed interactions, and potentially increase their
resource usage.