I think that I will chime in with the linux angle.
First I think Ubuntu is a great linux distribution and works great in the appropriate environment. Unfortunately a medical practice EMR is not one of them in my opinion.
1. Most users of AC still have need for other applications to work along side their EMR product. AC is not a monolithic system that encompasses all aspects of a practice's computer need. They are not an Apple. Even if you get AC to work on linux you will still have problems with software like radiology viewers, glucose monitor software, practice management software, etc. Many software products used in medicine do not have a linux version. Also hospital products will more than likely not support a linux installation.
2. Unfortunately a lot of web based software used in medical technologies requires internet explorer. I am not going to debate IE verse firefox. You could use WINE or Crossover Office to run IE but you would still need a windows license and use of IE on linux is a legal gray area (although it works fine).
3. Ubuntu server is not "easy" to use. Although a great product, the fact is most AC users are not going to be able to configure a server using the command prompt and hand writing config files. I have used both ubuntu and win2003 SBS. SBS is easier to use with the wizards. More importantly you can get help from local IT resources with Windows where linux support will be more difficult. Local hospitals will not support linux installations as they help their referral base practices install and maintain IT services.
4. You stated in your post about the frequent hardware and software changes that are required to use Windows. In fact ubuntu LTS 8.04 expires 2010 whereas Win2003 expires 2010 with extended support to 2015 and Win2008 expires 2015 with extended support to 2018. Ubuntu LTS has a shorter lifespan than Windows 2003 or 2008 as each LTS release is three years. Of course Ubuntu will still be supported in stable releases between LTS versions and the next LTS should allow migration from 8.04. Frequent upgrades is not always a bad thing.
5. Windows has a good remote access feature.
6. If AC were to use linux they would be better off with Red Hat or Novell Suse. They have better enterprise support features than Ubuntu. Novell would be a better choice since Mono support would allow .Net applications like AC 4.x to work (although the code would have to be validated and adjusted). Of course Mono works in other versions linux. I would defer further discussion to .Net on Mono to a developer.
7. Free is not free if it requires more time and effort to make work. Linux is a great OS in certain applications. At some point in the future I plan on having terminals for patients to access in the waiting room to fillout paperwork and stuff like that. Linux would be a great set up, secure and difficult to hack. Most patients would not be able to install extra software or violate the set up. Linux is much easier lock up and control access. Also linux makes a good router/firewall/filter that can be deployed in a practice.
Just my thoughts
Geoff
