Runbooks — Healthcare & Telemedicine Architecture

1. Onboarding Runbook (Clinic / Hospital Integration)

Objective: Bring a new hospital, clinic, or telemedicine hub into the secure network fabric, ensuring compliance and clinical readiness.

Step Sequence:

Pre-Validation
- Verify DIA/SD-WAN circuit availability.
- Confirm HIPAA BAA (Business Associate Agreements) with carriers/clouds.
- Register site in CMDB (with compliance tags).
Edge Deployment
- Ship SD-WAN/SD-Branch appliance, LTE/5G dongle as bootstrap.
- Set VLANs: clinical apps, IoT medical devices, guest Wi-Fi.
Zero-Touch Provisioning (ZTP)
- Device phones home to orchestrator.
- Apply policy templates (role-based ZTNA, QoS for video/voice).
Security & Compliance Enrollment
- Certificates provisioned from HSM/KMS.
- ZTNA profiles applied: doctor, nurse, admin, patient IoT.
- SIEM log streams enabled; logs tagged as PHI-sensitive.
Clinical Application Testing
- Run telemedicine video consult with QoS metrics.
- Test EMR/EHR access latency from local, remote, and cloud.
- Validate DICOM imaging throughput (radiology).
Handover to Operations
- Mark site “Production” in ITSM/CMDB.
- Enable 24/7 NOC/SOC monitoring.

Logos mapping:

Objective: Maintain clinical continuity if primary internet fails.

Step Sequence:

Detection
- AIOps alarms on packet loss >1% or latency >100 ms.
- SD-WAN flags DIA down.
Automatic Failover
- SD-WAN routes clinical traffic over LTE/5G or satellite fallback.
- QoS prioritizes: telemedicine video, EMR/EHR access, IoT patient telemetry.
- Guest Wi-Fi or non-clinical services de-prioritized/throttled.
Validation
- Synthetic telemedicine call launched.
- EMR/EHR query response time measured.
Notification
- NOC generates ticket, notifies hospital IT.
- Carrier escalation started.
Recovery
- On DIA restoration, traffic reverts with no session loss.
- Postmortem generated with SLA breach notes.

Objective: Contain suspected PHI exfiltration or credential misuse.

Step Sequence:

Alert
- SIEM flags unusual EMR queries or outbound transfer attempts.
- CASB detects anomalous SaaS access (cloud EHR).
Containment
- ZTNA revokes user/device session.
- SD-WAN microsegmentation: isolate IoT/medical VLAN.
- FWaaS rules updated to block suspicious flows.
Eradication
- Endpoint isolated and reimaged.
- Credentials rotated; MFA re-enrolled.
Recovery
- Clinical apps restored; monitored with APM.
- Confirm PHI logs unaltered, audit records intact.
Postmortem
- HIPAA breach report triggered if necessary.
- Lessons fed to SOC and compliance team.

Objective: Rehearse recovery if a hospital or clinic loses network access or suffers catastrophic failure.

Step Sequence:

Scenario Trigger
- Simulate hospital site outage (power, flood, cyber).
Failover Activation
- Redirect telemedicine sessions to cloud-hosted instances.
- Activate alternate hospital/clinic as surge site.
- IoT telemetry rerouted via LTE/5G direct-to-cloud path.
Critical App Validation
- Confirm EMR/EHR access through alternate region.
- Validate PACS/DICOM imaging accessible at failover site.
- Synthetic telemedicine consult from patient home kit.
Time-to-Recover Measurement
- RTO/RPO logged.
- SLA thresholds compared to HIPAA requirements.
Debrief
- Incident reports circulated to compliance + clinical leadership.
- DR posture adjusted based on findings.

⚖️ Logos Framing

Onboarding = spelling a new clinical node into the sentence of the care fabric.
Failover = substituting synonyms to preserve patient meaning (video consult → LTE instead of DIA).
Incident Response = correcting semantics when PHI context drifts.
DR Drill = recursive rehearsal, ensuring clinical pragmatics hold under chaos.