Home Forums Discussions General Discussion Starting New Practice - need your blessings

Hello Everyone,

First off, I wish you a Merry Christmas, Happy Hanukkah, Happy New Year and all too common and hypocrite/PC Happy Holidays.

I will be starting my own practice in mid 2009. I would greatly appreciate if I can get some guidance/cyber-mentorship from you wise and experienced folks.

My set up would be a base clinic where I can set up a server (or big desktop) and internet (T-1 is not impossible to consider, if need be)and 'girls'. My preference will be to stay as paperless and electronic as possible. We will have upto 3 'provider' working at one time- 1 at base clinic and 2 at satellite clinics. Satellite clinic will have an internet connection, laptop(s) and one girl to room pt in. Only Doctor visit there, and no procedures.

I will prefer electronic faxes coming straight to my desktop/server/satellite laptops. I will prefer using virtual PBX/answering system alternative. Would prefer to fax electronically. would have forms and photo and card and ID etc etc stored electronically. Ideally, dollar bills would be the only paper in my office.:-)

First issue I would like to answer for myself is what kind of hardware set-up would you recommend to meet these needs?

Please pardon me for not sharing my real name for next few months until I am out of my current contract.

Happy Holidays to you as well.

Any hardware setup you would likely use is sufficient. If new, they will be good. I even ran V4 beta on a 400 MHz Win 2K machine. I prefer XP to vista, less memory needed but both will work. Any dual core is fine.

I would recommend hard wired with 1K router/switch. Wireless is much less predictable, slower and less secure.

Faxes: many use Brother 7840, I have one office running on win fax. former is somewhat more reliable. You might also consider one of the internet incoming fax services. All will give you files as PDF. (Well, winfax won't, but easy to convert.)

We have 2 offices and they have separate databases. You could try running a VPN, it would be somewhat slower, maybe not at T1 speeds, but T1 would need to be on both sides. Syncronizing is not perfect on AC yet, (I haven't tried it on V4 beta yet.) It is one satellite or 2? More sites make syncronizing impractical.

Server vs desktop. Server will allow more connections, but with 3 providers and even 4 staff you could run peer to peer. You would need backup service, but there are many programs that would do it for you.

Thank you Wendell for your note,

I have been reading some posts and these are 2 options I have come up with:

1) Put database at a high quality desktop and keep it at place with most speed need (eg receptionist). Access the database in same location with wired network (this, I believe is called P2P)and with VPN or Logmein or gotomypc from remote locations (satellite clinic/home). May switch to server/client in future as per the need.
or
2) Put database on a server with server OS and access it with wired network in same building and with VPN or Logmein or gotomypc from remote locations (satellite clinic/home).

Since I am starting from scratch, there will not be much database and in the beginning only 3-4 people need access to the database (me, recptionist, MA, part-time biller). In the very beginning, MA may serve as receptionist.

Faxes can come straight to the database.

Phone calls can be handled by the virtual PBX.

Which of the above 2 options would you gurus prefer?

I think vista is the only choice left now. Getting and maintaining XP may be difficult in future.
Does AC work with Apple/Mac?
What is the min hardware recs would I need ---- I guess HDD 100GB+, RAM 4GB (or more?) any vista ok? any particular preference for anything else --- card or another hardware or something?

when I am using it from logmein, can my receptionist access the 'main' desktop at the same time?

Thanks in ad.

Should I use tablet PC instead of plain laptop? Do they work well with AC?

I am not knowledgeable enough to give you good advice on most of this. I can tell you what I have done, and especially what I have done wrong! We currently run a big server that is probably 10X more than we needed, long story. HOWEVER, with the server, and it's very fast cpu's (yes, plural) we can run workstations as "thin clients" which are like dumb terminals. But when you do that, the network does NOT need to send you all the data, only a picture of the screen as it would be if you had the data. Sorry I am not making this clear, but maybe this will help. Quest Diagnostics sends labs into the system direct. The format that it is in takes AC ver. 3 over one minute to open the file IF I am retrieving the file via our INTRAnet and on a wireless laptop. No matter how fast, how many Gigs, blah blah blah. When you are on "Remote Host" (directly on the server, your keyboard, mouse and monitor are just like they are plugged into the server) the lab opens very quickly, as does every other function of AC. It does not seem to be affected by how many in the office are working. We have 3 Drs. and 12 employees.
Point is this, initial cost was very high for server and setup, but now it is starting to pay some dividends.

The other big mistake was Tablet PC's. We had three computers that were pure tablets. We broke one in the first month, and the other two were only useful for us with a keyboard plugged in. You need a keyboard and the times that the Pen is cool, just aren't enough. I have for my personal use a Fujitsu Lifebook T-4220 convertible tablet/laptop. I love it, but I am not sure it was worth the money, (over 2 grand). I can work just as fast with a $1,000 laptop and could have bought two, putting someone else to work!

Thanks Doc Martin.
Should I use a high end desktop/tower for server or use an actual 'server' server?

Is this laptop a good one-
http://www.officemax.com/omax/catal...de=cii_10043468&cpncode=22-2629769-2

PKA,

Good luck with your new practice, and we all understand the need for confidentiality with your "old" practice. And, everyone here will be very helpful. This is probably the best message board for EMRs or anything for that matter. I have learned a ton from my colleagues on here.

That said, and please don't take any of the next few comments the wrong way, but setting up your network by asking this many questions will simply lead to chaos. If you ask specific questions when you are at certain points in the process, it will be more helpful. For instance: "We are going with Vista, which version should we use?"

A NETWORK NEEDS TO BE DESIGNED! This means what type of PCs, do I use P2P or server/client, what specs in the PC, what specs in the server if I use one, do I go wireless or wired, tablet or desktop, Cat6 or Cat5e, what brand of laptop, PC or Tablet, where do I put the database, etc. etc. etc. When you combine all of those choices, number of possibilities is endless.

Think of it like a car. You could ask each of us what car and what amenities and features we would suggest, and you would get everything from a Ford 150 to a Jaguar of Mercedes. They all get you from A to Z. Of course, Paul would say a Jeep.

I despise wireless, but my office allows wired. Some offices don't or some offices want to move laptops around. I am a client/server DOMAIN (just because you have a server with a server OS doesn't mean it is a domain) but most on here use P2P, and it is just fine.

I have never owned a laptop in my life, but laptops work great. What works best for YOU?

I would highly suggest you buy a cheap book on networking. Even Networking for Dummies (I have a copy) is OK. PLEASE hire an IT consultant at least for the initial setup. Given the number of questions you have (which is great!), you could probably use one.

Not to belabor this point, but when you go out to purchase a Smartphone or cell phone, the first thing you have to do is decide do I need email, do I need to text, is the phone more important than the PDA portion, what reception do I get with each wireless company in my area. Hopefully, you don't just buy a phone.

I would sit down and design by looking at the key things you want and what would work with your office. Of course, ask for help on those as you go. For instance:

1. Do I want PCs or laptops or tablets? Well can you put a PC in each room? If not, then you have to with one of the latter two. Do you like the stability of having a PC in each room (as I do), then go with that?
2. Wireless or wired? What is your building going to allow? Can you even run wires? Or is wired not secure enough?

There are many threads and topics on here but, by far, the big three are 1) networking, 2) backups and 3) PC to fax and Fax to PC.

To answer a few questions that area screaming to be answered (at least for me):

What version of Vista. PLEASE, PLEASE, PLEASE...get Vista Business or above. Do NOT get Vista Home. It's called Home, because it is used at home. Very difficult to network with Vista.

XP has many years left, IMHO. Best OS ever made by Microsoft. But, you are right, Vista and 7 are going to take over, unfortunately. Make sure you get XP Pro and not Home.

Do NOT put the database on a computer you will be using. SEE THIS IS MY THING AND OTHERS WILL DISAGREE. With a good network, your receptionist will have no issues accessing the database with good speed especially with V4. Your receptionist will use his or her PC probably the most. With the best change of needing reboots, etc. Do you want the database down while Windows takes it sweet time rebooting?

As to LogMeIn, the answer is yes and no and please don't. Yes, you can both use it, but whoever has the quickest mouse will win. Now only one LogMeIn user can log in with LogMeIn at one time. I wouldn't use VPN if you have this many questions without some help. Go with LogMeIn. Free, secure and fast. Not as fast and secure as other remote solutions but good enough. Also, the LogMeIn user can turn off the host computers mouse and keyboard so if that is set, then he or she could not use it.

As a small suggestion to be politically correct, I may stay away from "girls" and use staff or women. Just a tip. My staff likes to refer to themselves as "girls." So no big deal here, lol.

Ah!
Bert
Just the man I was waiting for
let me read your post and respond in a minute

my 'old' practice is with a blood sucking HMO, so you know the deal
thanks for being understanding, you all ACers
I am a moron tech-wise, so you can expect all sorts of stupid questions from me :-)
my aim is efficiency without shelling out 10s of grands.
I am much more comfortable with laptops/tablet.
agree that it is quite a pain to network with vista, home is the only one I have tried
I recently tried Mozilla and I swear I would never go back to IE, unless they put a gun on my head ....... and may be that means I am drooling for alternatives to other microsoft stuff. I did not do well with linux, I did not use it enough to get addicted to it and at that time, I was using XP.
Can we use AC on Ubuntu ??????
Ah! I learnt the word 'girls' right here only, buddy. I dont think I would have girls, anyway.... just one girl, maybe maybe..........

I agree with BERT, but I will tell him I am going to the CLOUD. That is the future of database storage. With the database in the sky, you can get away from some of the other network challenges.

for remote Access I recommend VPN but I also us TeamViewer. www.teamviewer.com.

SmartPhone - I am a dyed in the wool Microsoft developer. The best smartphone ever built is the Apple IPhone 3G. The Browser is A REAL BROWSER. If you have to use a Windows Smartphone, you must use the Skyfire Browser. www.skyfire.com

Design your network, design your network. If you can't do it get a professional to do it.

Enjoy!

HI PKA,
I understand the confidentiality issue. I was in a similar situation several years ago.

I would echo some things that Bert said. Your question is a little like asking "should I live in the country, suburbs, or city?" I am being facetious of course. There are so many different design concepts the possibilities are near endless.

It boils down to this question: what are your needs and how much finaniclal resource do you have?

Regarding locale: base clinic and 2 satellites. If these clinics are open at the same time, you need high speed internet or T-1 connection (preferable). DEFINITELY NEED A REAL CLIENT/SERVER IN THIS SETUP. THIS IS CRITICAL, YOUR WHOLE NETWORK WILL NOT WORK WITHOUT A SERVER. SOME WILL TELL YOU IT'S POSSIBLE TO RUN ON REGULAR DESKTOPS USING SOME CONFIGURATION OF LOGMEIN, REMOTE DESKTOP, ETC. HOWEVER IF YOU WANT TO BE SETUP FOR SUCCESS, YOU NEED A SERVER. ANYTHING ELSE WILL FAIL. I CANNOT STRESS THIS POINT ENOUGH.

Electronic faxes coming straight to my <<server>>: This is pretty easy. Buy/lease a networkable fax (or all in one fax/copier/scanner/printer). Many options exist and you can search the AC posts for more on this, several threads have been run on this topic. This you would setup to store images on the server, so all client computers can access a shared fax folder.

Using virtual PBX/answering system: Onebox is your solution. Don't waste time researching others. Use Onebox. Go to www.onebox.com
Use the Receptionist plan. You can get up to 10 lines. It has an auto-attendant to answer phone, select by number the person they want to talk to, highly advanced call forwarding. One single toll free number answers your phone AND faxes AND email accounts are included. CHECK THIS OUT. IT's AWESOME. I threw away my pager 3 years ago, I get all after hours calls forwarded to cell phone and I'm alerted by text if someone leaves a message.

Prefer to fax electronically: again this is easy w/ a networked fax machine or via Onebox.

Have forms and photo and card and ID etc etc stored electronically: use the scanner feature of an all in one fax/scanner or buy the tiny desktop credit card/ID scanners.

Dollar bills would be the only paper in my office: You can be as papered or paperless as you want to be. I am virtually paperless, so is Bert. We do use paper daily, but very little. It funny, I can never quickly grab a sticky pad from my staff when at the front phone because they never use them anymore. They take all messages directly into A.C.

To address some of Bert's comments:

On wireless: I agree, don't use it. It sucks. I've tried it and wired is the ONLY way to go. No matter what you do, wireless signal occasionally drops for a milisecond. That breaks the connection to the AC database, and reconnection is known to corrupt the database. That being said, I had at least 250 disconnection/reconnections in the 6 months I used wireless. I never had a database corruption issue. But don't chance it. Use wired (it's also more secure). Sure you can make wireless highly secure, but the more secure the encryption the longer the encryption/decryption process and thus slower network speeds.

On laptops: I have two, for my two main exam rooms. I can easily relocate a laptop to my pap room for the 6-10 paps I do per month. Much easier to move than a desktop. Why not just have 3? Cost. Another practical reason for laptop, is tax write off and home computer use. My home PC is one of my office laptops. I just take it home most nights/weekends. I use it from the comfort of bed or sofa. One other thing I like, personability (if that's actually a word). Laptops are small, compact right? Placed on a mobile kitchen butcher block that I bought at HomeDepot, I can face the patient and type at same time. No matter where they sit, I can move the computer so that I'm facing them and making eye contact. Not many here talk about this, but it's a HUGELY underappreciated concept. Patients don't mind you typing while they talk provided you look at them once in a while to let it known you are truly listening.

On hiring IT person: you can if you want, and I highly suggest you do so. It is worth the investment in your case. Mainly due to the 3 offices being interconnected. If you had just one office, you can figure this out on your own. (Networking for Dummies is truly helpful). If you have time to mess around with your setup before your office opens, play with it. Break it and fix it. Take it apart, put it back together. That's the best way to learn. Others here have hire IT people. I never did, just figured it out on my own (50%) and with tons of help from Bert (50%). However putting 3 offices together is not simple to throw together. Some here will make it sound like it is, but in order to make it work properly it's quite challenging and costly.

On Vista: many will tell you to use XP Pro. Sure its good but Microsoft won't support it forever, so join the crowd like I did and get Vista. Use either Vista Business or Vista Ultimate. DO NOT USE VISTA HOME. This is incompatible w/ a client/server domained network configuration. I've used Vista Business for 1.5 years, it works fine. I got over XP, eventually everyone here who loves XP Pro will have to get over it as well.

On where to put the database: I agree completely w/ Bert "Do NOT put the database on a computer you will be using. SEE THIS IS MY THING AND OTHERS WILL DISAGREE." No one should be using the computer upon which the database resides. You'll hear all sorts of examples why you can still use the computer upon which the database resides. However that doesn't make it a smart thing to do, that is just not right. This gets back to my first statement, use a dedicated SERVER.

On LogMeIn: definitely DO NOT use this as a means of doing routine daily work while you are seeing patient. This is only correctly used when you are home, need to get some office work done and need to log into your desktop computer to review faxes, address messages in AC, check email or whatever. Here's a huge drawback, if two people are on at same time it's not usable plain and simple. Bert says, "I wouldn't use VPN if you have this many questions without some help." I totally agree. If you are having 3 offices interconnected AND you want reliability in connection up-time AND you want it to work quickly enough to make it usable, you DEFINITELY NEED AN IT PERSON TO HELP SETUP YOUR VPN. This requires routers for security, VPN tunnels for speed, and you can't truly make this work with an off-the-shelf firewall/router.

Hey Jon, I should get credit for like 10 posts on this one.
Hey Hockeyref, the length of my reply challenges the length of your shortest posts (just kidding, truly meant in jest)

Hi George,

Unfortunately, I would have to live in Bar Harbor (actually that would be fortunate) to use iPhone as AT&T drops more calls than Terrel Owens drops passes. lol. Great quote by Alvin Toffler.

PKA, we are all here to help. Once you get an idea of what you want, then it is much easier to give some advice.

Remember an important concept: People will recommend what they like. I love SBS2003 so I tend to recommend that. Actually going to 2008 now. That isn't always bad. I have helped a colleague here quite a bit who used a lot of what I recommended. BUT, the benefit is that it is easier for me to help in the future if it is things I am familiar with. I can recommend Unix or Vista, but I use them little so I don't know much about them.

I have a colleague in town who asks me a lot of questions about their system. I never set their system up, never recommended the setup they have (even though my opinion was requested). I find it doubly frustrating because I can't help very well due to my preferences are vastly different from theirs.

I'm going to let Bert learn SBS 2008, I'll learn from his mistakes then he can guide through the steps real easy. If I said, "Bert I'm going to use Linux now." Then called him every day to ask questions, he would disown me as a friend.

The point is, find mentors that are using the same system you end up using. That way they can give valuable help based upon shared experience.

This sounds like something right out of Friday 13th. How do your patients like the "butcher block?"

Hell of a good post, Adam. Very nice.

I ditto Bert. Dedicated server, clients on a domain, wired, and either PCs or notebooks in the rooms. I love having my notebooks on their own little tables so I am directly in front of the patient as I type. Check out the Dell site....lots of good deals going on now and, if it is your cup of tea, good leasing options as well. You can still get XP Pro (much to my glee as I am getting ready to purchase a new desktop for the back office) with option to upgrade to Vista Business in the future included in the price. I bought a Vostro laptop last fall to use as an extra workstation in the office and to take with me when I travel and it is great. I excluded the bells and whistles, got the basic hard drive, and upgraded to lots of processor speed. As your practice grows and you begin importing everything and adding pictures, having a good dedicated server with plenty of memory and processing speed and a stable OS like SB 2003 will hopefully serve you for many, many years to come. JMO.

Leslie

I recently built a server with the following specs:
4 750GB Hard Disks (RAID 5) for Data on a Adaptec SATA RAID
Controller
2 160GB Hard Disks (Mirrored) for OS
1 Dual Quad-Core Opteron Motherboard
1 Opteron CPU
8 (4 x 2)GB ECC RAM
1 500W Power Supply
1 Server Case with HotSwap Bays

Total Cost?
$2000.00

I also purchased an additional motherboard to use as a spare if needed.

If I need more speed down the road, I will add a second CPU and an additional 8gb RAM!

Every component was purchased at NewEgg.

Adam & Bert

On the VPN, the straight forward way to set it up is to have router to router tunnels. I use the Linksys VPN routers. Client Software on the computer.

The Linksys RV016 is a favorite of mine.

George,

You must be using 64 bit for that memory?

You are correct with the router to router.

NewEgg is the way to go on building PCs.

Thanks a Zil Gurus,

I think Adam did it. His post should count as 100 posts. <cyber-clap>

Without pretending that I just graduated from BS networking course, I will rephrase what I am concluding so far:

1) Need- My base office will be staffed by receptionist and part-time biller who will need to access when I am seeing pt with my MA-- sometime in base clinic, sometime in satellite location. Sat locations ARE all rural and rented and I dont think I can get anything more than an Internet connection +/- fax/phone there.
Base clinic can be wired, sure. Satellite clinic- may not.
Budget is a relative issue-- If I am more productive by spending 10k than spending 8K, I want to invest in myself. Its all about ROI.

2) Actual dedicated 'server' server with server OS (SBS2003) with clients on domain is the way to go. IT help needed but achieving self-sufficiency by learning is recommended

3) Need Vista Business. Laps are good. Tablet ?? not yet finalized. Of course, RAM etc need to be super.

4) All in one networkable Fax with software to get it electronic
Qn: which one? Scansnap does not have TWAIN

5) Onebox it is. Period

6)IT needed to set up best way to access server from satellite location. LMI/GTmyPC wont cut it. Probably VPN tunnel is the answer.

7) IPhone as soon as I am in AT&T zone.

8) Correction to
<Dollar bills would be the only paper in my office>
I am sure some CMS law requires toilet paper in place. One of the zillions unfunded mandates.:-)

Once again, I sincerely and gratefully appreciate your help.

PKA

PKA,

I didn't mean to sound unhelpful with my post. Just giving some honest feedback. I am always willing to help, and if you wish to email or PM me, I will help as much as I can. Email in profile.

To everyone:

One key point that sometimes gets lost in these discussions. While P2P and even using the PC with the database as a workstation may work well with Amazing Charts, we sometimes forget that many may be using their network/domain/server for other things besides AC. I, myself, run my billing software, AC, FAP and other mission critical applications and/or databases on the server. This can require a lot of RAM and a faster processor can't hurt.

While you can backup a workstation, it is safer and good to know that you are backing up a dedicated server (whether what I call a pseudo-server {dedicated workstation -- not in use} or a "real" server with a "real" server OS)

We as doctors, etc. are usually control freaks, and I think it is an accident waiting to happen if one of your staff who will not suffer much if all of your data is lost is the one changing tapes or backing up to hard drives. One key component to any good network for MISSION CRITICAL DATA is to have all data on one computer, have that computer isolated, and DO THE BACKUPS YOURSELF. And, test your backups weekly.

Just my opinion.

PKA,

You will have to give some credit as I woke Adam up and told him to reply to your post. He is the OneBox, Vista Business, Wireless vs Wired guy.

Bert

PKA, I will have to pass on the OneBox. I use the Linksys SPA 9000 PBX & SPA400 VoX. I bought both for under 500. I have 6 SPA 942 Phones about $100 each.

I have a DSL + 2 Business Plans from Teliax for $150/month. With that I get 5000 minutes monthly.

I do not favor comb/multifunction devices. My server also runs my FaxServer software, from SnappyFax. $69.00. Each workstation has SnappyFax client $29.00.

The thing to remember is this. Once AC goes to SQLServer there is much less demand on the network from a wired/wireless perspective.

Backups: I ditched the tapes and dvds a long time ago!!! I backup to SOSOnline. www.sosonlinebackup.com

PKA,

You are getting great information from everyone. But, I will try one more time to say SLOW down.

I am not a networking genius (networking can be a huge headache sometimes as troubleshooting is not always easy). It took me over two months to design my network including purchasing hardware and software. It seems you are trying to do it overnight. Just my observation. My sincere apologies if I am wrong.

If you are looking to connect satellite offices, then you may want to rethink wireless at the satellite offices. You can wire rented space. You may wish to consider VoIP as one of the biggest advantages of VoIP is that phones in your satellite will be like extensions of your phones in your main office. If you have Internet and Ethernet, you will have VoIP. And, you can take a VoIP phone on a conference to Japan or to your house and have local service with the same phone number.

Are you truly researching your OS? If you were and you are hiring an IT person, why not go with SBS 2008? A little silly to start fresh with an OS that is five years old when you have an IT person to set up 2008. Of course, it is 64 bit. Make sure AC is compatible.

Last time I checked there are two Vista Businesses. One is Vista Business-N. I could be wrong there.

Most networkable fax machines (MFPs) come with the software for PC to Fax. You can go with Brother at around $500 or more or go with Xerox or Toshiba at $7,000.00. As you said, you get what you pay for.

Scansnap is for scanning not faxing. TWAIN, while OK, isn't really necessary although it can be helpful. Took me and Adam over a month to research MFP and I ended up with four models, before I was happy with Xerox.

LogMeIn is great to remote into a computer to work on it but would absolutely not be a solution for connecting offices. There are other solutions. As you said, you will need IT? Who will you get? You may want to make sure they are SBS Certified with Microsoft.

iPhone is a good phone. I do believe it can work with Exchange Server. Or do you want to go with tried and true Blackberry with BES? Or use Windows 6.1? All things to research. Are you going to trust your entire office to a cell phone or am I reading that wrong? VoIP and OneBox and iPhone, etc. is great but sometimes good old POTS digital is the way to start off. You need a fax line and sometimes you will want a backup regular phone line anyway. There are phone companies which will set you up with both.

This is my last please. Please take you time and research things more. OneBox is great, but I wouldn't jump to it, because it works for Adam. Look at VMail, etc.

Bert wrote: "Of course, it is 64 bit. Make sure AC is compatible."

Bert if the AC4 Database is SQL Server then ONLY THE DATABASE will be stored on the server. The AC Application itself will be run on each Vista Client Machine.

Hi everybody,

I have decided to proceed with AC and I have been reading this discussion with great interest. Others who are just starting out are probably listening in, too. I will be using a much smaller network since I am a solo doc with 2 exam rooms, 1 ma, 1 receptionist. Since I am budget conscious (ok, I'm a cheapskate), I was going to try just a straight p2p without a dedicated desktop as a "server". It sounds like the concensus is that this is a bad idea. Ok, so should I get the meanest, fastest desktop I can and call it my "server"? Then maybe some day I can upgrade.

Thanks

Bill because I build my own servers, I build with an eye toward the future. For example, the last server I built, posted above has Dual QuadCore CPU capacity and up to 64GB RAM. I started out with a single QUADCore CPU and 8GB RAM. This means I still have room to double my CPU capacity and increase my RAM by a factor of 8.

As the cost for CPUs and RAM decreases, I can leverage my investment. So in short...build for today with an eye on tomorrow.

My Server Case: Click Here
My Motherboard: Click Here

Bill,

Heavens no. P2P is just fine. Again, to each his own. While I like a true server/client with a server computer and operating system, I used peer to peer for six years at my last office. Remember, you can have a "real" server and OS and still be peer to peer -- depends on your setup.

You could use just the number of PCs you need and even use one of them for the database. Adam and I are just letting you know the "risk/benefit" of this. I would look at it this way in order overall best way to do it:

P2P with one of the workstations running as the database "server."

P2P with a dedicated "server."

A true domain.

You can always move up.

Please don't take all of our posts to mean you HAVE to use a Dell Edge 2900 with ten hard drives in a RAID10 configuration with two dual-core processors and 64GBs of RAM on a 64 bit OS.

Three workstations each with 1GB of RAM is plenty, possibly going with 2GBs of RAM on the database machine. RAM is cheap and so is harddrive space. But, you can ask Adam, I ran my network on a HP server with 1GB of RAM for six months. To be honest, while I would never go under 4GBs of RAM which SBS2003 32 bit OS only "sees" as 3.2GBs of RAM again, I could hardly tell the difference.

PKA and Bill

All of the above are good advice.
I have 2 offices, one is on a server and one is not. I am frugal as well.

I have computers as slow as a 40 Mhz pentium 2 (mainly for faxes and old vaccine program, but it does run AC well) to Server with a Dual core and 2 Gigs Memory and 500 G hard drives (never got around to upgrading it, works well). Currently my P2P system is running on a XP system with dual core.

I had been building computers but recently have found a number of cheep (<$100)2.4-2.6 p4 machines, and have been upgrading them recently. Impressive increases in speed because of gigabit wiring, not necessarily from the computers themselves.

The bottom line is for a cheapskate (I am quite frugal) a fairly minimal system will work reasonably well. For more money, it will backup easier, run somewhat faster and interact in a more consistant manner that probably takes less tweaking.

Hiring an IT person would be a good thing if you do not have the knowledge or inclination. Mostly a 1 time thing for setup, although there is ongoing maintainence. They will guide you as to both hardware and OS's. While I never used one, I had friends who I consulted and read a lot, along with what I already knew. Without help I would have been stuck many times.

Server is probably better, but dedicated regular computer will work well. You need to decide both how much you will spend in the short run, and how much you will spend in upkeep over time. You need to have backup backup backup.

Bert, all the compliments to Adam are by default, compliments to you too and vice versa, .. we all know that and appreciate you two's presence here.
I am sure you folks will understand if I were to say that I will have to make a choice that I can work with and live with. I am kind of allergic to tech and too many acronyms can make me break out in rash :-) so I do have to take it easy.

Any role for AC offsite backup?

VOIP is a done deal. I see plenty of benefits. Skype can forward messages to your cell. Pretty handy.
I agree there must be at least one land-line, just in case of power outage or some disaster.

oops for the typo. It was meant to be SBS2008.

chill

I believe we are going to see a tsunami of unfunded mandates with the new team in DC.
Will AC be able to handle the storms of eRx, P4P and CCHIT etc etc?

PKA,

I was totally kidding. Skype is good. Many ways too message. As Adam says, OneBox is good with that as well, but he got in when the getting was good.

I used to be pretty high on offsite backup. Partly, because it had to make a local copy first, so it was 2 for 1. Unlike George, though, I do like to have many backups (back at least one month or more) onsite on my own backup hard drives. The newest version 4.0, has a built in backup. There are probably other online backups that would be better for your money. George mentions some; there are others. I am rather big on being able to go to the online storage and see my backups. They aren't any good unless you can download them and check them for errors.

You can do that with AC's offsite backup but not quite as easily, and you certainly can't go to their servers and look at your backups.

The day they make me eRx will be the day that I...well eRx. But, I don't have to like it.

this is by Roy in May 2007

<<I flew down to Anaheim to attend the Pri-Med West conference to pay homage to Jon Bertman. I had the opportunity to meet the founder/CEO of Office Ally. He came across as someone with a similar vision to Jon. He told me that there is no plan to charge for the PracticeMate software. I got Jon and OfficeAlly together and hope that a relationship can be established and encouraged both parties to work on a link so Amazingcharts and OfficeAlly can work seamlessly.>>

what is the current status of OA/AC partnership???

Bert never woke me up.

Business-N is not available in U.S.A., only Europe.

PKA, I have a Scansnap. It's ONLY a scanner. TWAIN or on TWAIN makes little difference in AC. You can just as easily scan to PDF format, drag and drop files into AC charts.

I use Muratec-MFX 1430, my all in one device. Not the greatest thing on the planet, but the price is right and it meets our needs with more than adequate speed and efficiency.

The thing w/ these devices is to think really hard about what your needs will be. Keep in mind you may be wrong intitially. I got a cheap desktop all in one model that got me through the 1st 6months until the money started coming in. Then I took it home where it still resides and got the Muratec.

There are perks to being your own business owner. When something becomes "obsolete" or "breaks" you can simply take it home **hint hint** Business gets the tax break and you don't have to spend personal funds on the equipment.

Bill, this is the beauty of solo practice. There is more than one way to skin a cat. Your example is the perfect juxtaposition to PKA's situation. He has a complicated network that he must build upon and therefore REQUIRES a very stable platform.

However in your situation, your networking needs are very simple. P2P would work just fine. It's a lot cheaper for certain. There are limitations, but it WORKS.

Just remember: use a DEDICATED desktop to house the database. If someone is using that PC while 4 others are trying to access the database, the whole system can slow down. Also, if someone inadvertently causes a Windows error and the computer unexpectedly shuts down......oops everyone is shut off from AC.

I used P2P for the 1st year of my practice. God forgive me for admitting this fact........<<gulp>> but I used Windows XP HOME edition. What part of HOME did I not understand???

Now Bert, ask me who has a Dell PowerEdge 3200 that weighs 200 pounds and the only Server function it carriers is to serve as a heater for a private office.

Ok, a dedicated desktop to house the database it is. Anything wrong with a Celeron processor?