Home Forums Discussions Problems No room to setup AC server

Hello
I am setting up a new practice. Will start by subleasing existing office space parttime. That means I cannot leave the main computer that runs AC on site. The only option that I can think of is to get a remote dedicated sever with a hosting company and install AC there. But then that means I have to set up a VPN to access the software from my and my staff's computers. Since the internet access at the office space is not wireless, and is behind a firewall, I think I will have to get laptops with wireless internet access from something like Clear Internet ($50/month per user for internet access)to access the VPN. I tried to get a Virtual Dedicated Server from a hosting company, and use the Himachi VPN from LogMeIn, but it turns out a virtual server does not allow full installation of the VPN software. So I will get a physical dedicated server (about $100/ month).
As you can see, this is getting complicated and a bit costly. It would have been easier if AC had a web browser interface. Any suggestions on how to deal with my situation, if there is an easier way to set things up, are appreciated. Of course I can use LogMeIn for remote desktop access of the server, but that means only one user can run AC at a time.

Thanks
Khaled
Gastro
Belmont, NC

use a single laptop and backup nightly.

Eric
How about the other users who need it simultaneously? The front office for appointment, the nurse doing vitals etc.

You may need a couple of laptops:
1) Front desk and possibly nurse to schedule and imput vitals
2) Travels with provider from room to room.
A wireless router needs to be connected to the stationary laptop to make it easy to connect. You may be able to connect direct between the two, but I have never tried this.

At the end of the day, you pack up the two laptops and router and go home.

You could run a backup on the main (probably front desk on this abreviated system) and save a copy to the other laptop so that if it were to crash, it would be a relatively simple matter to flip the "main" computer.

This would also require that you set up both computers as "mains" so that they have the SQL server set up, even though one is running as the workstation.

Not ideal, but it will work until you can secure a more permanent location to store a "main" computer.

Laptops are cheap these days.

Wendell
So what you're suggesting is have a stationary laptop in the office that acts as the main machine, and set up a wireless router to connect that to the MD and nurse laptop?

One basic question: is the wireless router any different than the wireless router I use at home with my internet? I can't network my home computers to each other through that.

Thanks
Khaled

As this is part time office, avoiding any extra expense is likely a key objective. If you can't live without staff at startup, an extra laptop would be needed for each staff member.

The laptop at front desk should be fastest and most expensive if the database will reside there.

If you can use existing network, wired connection is simpler, more secure and likely more reliable. Especially important for the laptop with database instance.

A wireless router for this situation is same as you buy for home. If you go that route, be sure to turn on the security, don't broadcast the SSID, & restrict to certain mac addresses. Simple best practices need to be followed.

Short answer Yes and Yes
One of the laptops will be the main machine. You may be able to connect them without a wireless router, but I have not tried this.

You certainly can connect them (peer to peer) with a router (same one you use at home, I would recommend all be on N but G is very adequate.)

You can network your home computers like this. They should all be on the same network ("workgroup" or "mshome" I think are the XP defaults). If it's windows7 then they need the same homegroup password. Then you just have to right click on the folder you want to share or put it in the shared folder (find that in my computer above the hard disk.

Same principle here, share the AC folder on one("main") but not the other. Even though both are "fully loaded" programs with the SQL server (in case there is a problem and you switch to the other) only 1 AC folder will be visable to both.

You should use strong encryption.

I tend not to send out my SSID name, this adds another layer of protection. To log into your network, they need the name. I'm sure there are ways around this but it may help.

I would not use the default name from the router. Once you connect, it will look for the network and it already has the name, so connecting is not a problem. Occasionally it is with a new computer.

The laptops can then be secured in place when you have a permanent place and continue to be used, or be your flexible option.

I very much prefer hard wiring, but in this case, wireless makes a lot more sense. Speed wise, N is faster than 100 but not as fast as gigabit. Again, more than adequate unless you have a lot of concrete walls or metal in the building.

I wish I were not so ignorant. Bear with me. After I describe the "thingy" and "gizmo", someone will explain what I am talking about. I recently saw, but did not buy a cell phone device like an aircard. It is a phone service that plugs into your USB on ONE of the lap tops, (obviously your staff at the desk) and will netword up to 5 (FIVE) computers on it's wifi. It was in the neighborhood of $50-70 dollars a month I THINK, and needs a 3G network (available phone service) to give you decent internet. I THINK it behaves like an N wifi and the better laptops will have that. So you have one good lap top for yourself, Wi-Fi to girl at the desk. She has your database so she needs the bigger memory and should also be fast but is OK with N wifi card since she is plugged in direct? The MA who does vitals can get by with a $500 or even less, lap top. I am thinking less than $2500 for the whole set, and it can ALL be used when you get the new office.
Bert? Wendell? Indy? somebody help, I don't know what I am talking about!

I should proof read! But you get the idea.

I agree with what Martin and Wendell suggest. However, I believe you have to balance the amount you can afford and the simplicity of your system with your fear of losing data. I'm on the terrified side, so we dumped a lot of money into a very redundant server system which you can't do, primarily because I would go nuts relying on a simple backup. Using the AC remote backup helps a lot, but I can see someday having our files outgrow what we can reasonably backup this way. But, if you rely on a 3G connection for this sort of thing, it may not work well enough. The simple wireless router will work fine, and you can tuck it into a desk drawer when you leave.

BTW, Khalid, since you are gastroenterology, let me tell you another trick I learned. I do my endoscopies at the hospital procedure room, which uses Provation as its endoscopy software. I take a thumb drive with me to the procedure room, and plug it in to the terminal I am using. When I print the report from Provation, I can choose which printer to print to. One of the choices is a pdf program that lets me send the report directly as a pdf file to the thumb drive. I then take the thumb drive back to the office, and import directly to imported items in AC This leaves me with a full color, high resolution version of the report and pictures. I am also using UpDox, and then send a brief report and a copy of the procedure note to the patient and/or referring physician.

Martin is describing 3G mobile broadband. Here is a link to verizon's website: Verizon Mobile Broadband There are similar offerings from Alltel Alltel Broadband , Sprint Sprint Mobile Broadband , AT&T AT&T broadband . For internet access in your situation, this is a great way to go. I'd be careful of AT&T though as they are having capacity problems due to iphone usage (see WSJ article on network capacity concerns )

Thanks to all for chiming in.

One thing I'm still not clear on: if I set 2 computers as "main" with both having installations of SQL Server, but only use one of them as the main machine and have the other work as a client only (as Wendell suggested). How would the secondary machine go the SQL server on the main machine and not use its own? How would a full installation of AC function as a client?

Also, regarding internet access, anyone has input regarding Clear Internet? they say they are faster than 3 G. And, technically, I don't need internet to run AC, right?

Thanks

1) You can set the second computer as "one you take off site" that gives it full SQL capability as needed, but would normally use the PATH you set on the other main.

2) You do not need internet to run AC, but at least once every 4 months it needs to log on and check to see if you subscribe to maintenance/support or it goes into admin mode and you cannot add new notes- That means you have to log on occasionally.

Ok. I'll have to see how specifying the path works once I get the laptops.

Two more questions: my understanding is that several users can be using the SQL server back end at the same time, but, at any one machine, only one user can be logged into the front end client. In other words, you cannot start multiple instances of the AC client on the same computer, right?
The reason I'm asking is, if I'm going to make the front office computer the main one as suggested, what happens if I'm at the hospital and need to access that machine remotely using LogMeIn or Remote Desktop while the receptionist is inputting appointments?

The other question: wireless routers need to have an incoming network cable with internet signal. If I'm going to be using 3G mobile internet on the main laptop with a USB adaptor, how am I going to hook the router to that laptop?

Thanks

1) That is a problem - you cannot access and use the front desk computer while she is using it via logmein.

2) I would look into your 3 g mobile internet - Verizon offers one that the modem actually does not hook to the computer and instead becomes a wifihotspot. You also can buy routers that do the same - the USB hooks to the router and it becomes a wifi hotspot.

OK. So:
1-one powerful laptop that will sit by itself not used by anyone, and running as the AC server. That way if I needed to access it remotely with LogMeIn it's available. And just in case one of the office girls spills coffee on her computer. Don't want that to be the server.

2- Then one medium end laptop for the front office with an AC full installation but will run as a client.

3- 2 Netbooks (small, portable and inexpensive) for me and the MA. These will be moving between exam rooms, etc.

4- Get mobile internet that I can hook directly into a router that will act as a hotspot in the office for all 4 computers.
Does that sound like a reasonable set up?

Thanks,

I would double check the assumption that you will need to remote in from hospital with logmein. What device would you use to remote in? what data would need to be accessed in this fashion that is not available to you in hospital record system? what is frequency? if infrequent, a phone call back to office may be just as workable. Also, since this is a part time office, would you really have your office staff working and laptops connected when you are not there? No need to necessarily answer these questions on here but you want to be sure of need.

Eric
Even if remote accessing from the hospital is not all that much needed, my thinking is that I wouldn't want the front office person using the main computer that houses my EMR database as their appointment computer. That's why I think I better leave the main laptop not used by anyone and tucked safely in a back room. I can't use it for patient note entry since it's probably gonna be a bit big and heavy and in case I drop it. Does that sound reasonable?

As far as not leaving the computers up while I'm out of the office, I think some of that will be inevitable- even in a full time office. Could you give me more insight about this point?

Thanks

A lot depends on how long you expect the system to continue. What I described was a short term (<1 year) solution.

While I agree that having the main computer as the front desk is not ideal, it is a practical alternative especially if it is frequently backed up.

You could take your other computer to the hospital and use it, then sync rather than relying on a logmein connection.

Unless you are very busy, the MA could use either the front desk or your laptop to enter in vitals and CC.

It is a practical system that is using 2 laptops. Now I will not argue that 4 might not be better, just that the cost now increased by 50% (netbooks are cheaper than full laptops).

This then means you have to move 4 computers and router which is more baggage you will want to minimize.

I'm confused. Are you saying you are there part time, and then someone else comes in and uses your space so you have to take your computers and everything home with you?

Bert
Right, that is the case. I am expected to remove everything at the end of the workday, or at least not leave anything big. That's why we're thinking of using laptops.

Wendell
And you're right, I need to keep it simple. May be I'll scale back.

I checked with ClearWire internet. They have 4G coverage and they do have USB modems that I can plug into their router ("Clear Device") that will create a shared WiFi signal for all machines.
Thanks

I started to write back do you need WiFi for all the machines?, but once I realized how often I use the net decided that was moot, and it is a good idea.

I am coming a bit late to this party, but as someone who has both a main office and also sublets space, let me add my two cents. First, it is reasonable to expect your "landlord" to give you some permanent space, even if it is small. For example, a closet or file cabinet for supplies, samples, etc. I would ask for a small area for those things AND enough space for a small desktop and a router. Dell has some decent relatively inexpensive desktops with a pretty small footprint. You would need about 2 square feet on a counter or shelf.
With regard to internet access, can't you just get a cheap DSL connection to the office? In our area, Comcast and Verizon are competing for business customers with various packages-you might even save money on phone service by combining them.
So you have a desktop that stays in the office (cheaper than a big laptop), your front desk person brings her laptop and connects when she is in the office, and you use logmein from the hospital, home, or anywhere else. (Which you can do, even if she is on her laptop accessing AC over the wireless network).
And....when you end this temporary set-up, whether it is in 6 months or 3 years, you don't need to change your hardware when you move to your own office.
Will that work?

I completely agree with Jon. I guess it is a bit difficult after the fact, but I don't understand having to take everything home after. That just seems odd. How much stuff do you have to take home?

I would ask for some space and set things up as Jon states. Personally, I would do it wired. It is only an advantage to your landlord since you would have to leave the Cat6 behind. That's kind of the renting law I believe. I can tell you that the doctor I lease from is going to have a much better area to rent with the wiring that's been done. Of course, it has to be done professionally.

I love Smartphones and use 3G, etc. But, I have to admit I know way less than what everyone is talking about on here. I have no reason not to believe them, given I am completely ignorant about the setup, but it just seems like it wouldn't be reliable. Just a guess, though.

Bert and Jon
Sorry I haven't checked the boards in a few days.
- The office space I'm using is subleased and shared part time in a building of medical offices affiliated with the local hospital. They have their own existing computers, their own internet access and existing networks. That's why I don't think they don't welcome me installing a new phone line with DSL, or leaving a desktop server. I will ask again, though.

- Since I don't have access to the office at all times since there might be another practice using it, I prefer to have the main computer be a laptop that I can take home with me and run it there.

- Right now I'm only working in my new office practice 2 days a week. But I have calls coming in everyday from patients and referring physicians. So even though my staff may not be at the office, they will need to access the EMR for scheduling from their home. I forward the office number to their cells. That's why I need them to take the computers home with them. It is odd, but that's what my current situation with new part time office practice.

- Jon, you raised another question in my head: what happens if two people are trying to access the server remotely with logmein?

- I do realize that I'm coming across as complicating the setup unnecessarily, but I hope I managed to explain the peculiarity of my situation and why I need to do things a certain way. If anyone has a simpler setup that I haven't thought off, please let me know.

Thanks

Khaled,

Well, I feel bad because I can't help you. And, you will probably hate my advice again. I guess the negotiation is over, but I would still go back and ask. I do think you are making it way too complicated, and think there will be glitches; not to be negative.

Personally, and I am rather secure with my network, I have no problem leaving computers where others use the same space. Granted, I would not really want them sitting at the same exact desktop where my computer is (and I freaked out when my new cleaning person moved the computer three feet to clean).

How about this. It's crazy but who knows. Do you know of any other office adjacent to yours you could put the server it? Then run a cable through the wall. The downside would be access.

The person you are leasing from has computers. He/She has to know you need them. Think of what you need and tell them what you need to work there.

Gee whiz.get a cheap server. Put it and a wireless access point up in suspended ceiling. VPN to access point when not in the office and use Bluetooth when local. Could use closet even. Get good networking person to set it all up. The fixed part will not be expensive and will be removable in fifteen minutes when you finally outgrow temporary quarters

Khaled,
Your situation is not that odd, especially for a specialist just starting-up and trying to minimize overhead. Nonetheless, I think the advice you are getting here points out that sometimes trying to keep it inexpensive and simple may actually make lead to complex and expensive solutions....

In answer to your specific question, "what happens if two people are trying to access the server remotely with logmein?"...the first one gets bumped off. I don't know of any way around this.

How will you handle incoming phone calls when you are in the office? I have NEVER heard of a landlord who won't let you put in a phone line (and of course, a DSL is really the same).

Not to beat a dead horse, but you can have your server "locked" so no one on-site can access it when you are not there. "Taking it home" is NOT an advantage in your situation, because others need to access it. The database must be accessible to your staff, so I would keep it in the same spot (the office where you see the patients).

If you must do it the way you propose, some of the others on the board with more networking know-how than I possess may be able to help you.

Jon
Sorry again I was away from the Boards for a while.
I am not trying to do things inexpensively (at least as far the EMR and computers part go), it's just that the building is owned by the local hospital and they have a smug attitude towards MDs' requests. That's why I have been having a hard time getting 'reasonable' requests accomodated.
I think I will eventually be able to leave a computer in the office (either desktop or laptop), and will be able to either tap into the building's internet pipeline or bring in a new phone line for DSL, and use a VPN for offsite access by me and by the staff.
I realized a while back that using LogMeIn was not going to be a viable option.

(After getting the current situation taken care of, I think my next order of business would be to get a different office space with a more responsive landlord. But then I'll have to secure more financing to be able to afford full-time lease and employess till the practice picks up. But that's another story )
Thanks for the input

Hello all
Just to update everyone on the outcome of this issue. I"m using an all-laptop setup and it's working well for me. So one laptop with 4 gigs of ram for the server. Clear Wireless internet access with a ClearSpot wireless hub. Three laptops for me and the staff. When I'm not at the office, I put everything at home and leave them on, and the staff accesses their computers using LogMeIn.
Of course the uneasy part is lugging 4 laptops in and out of the office, but it's a small price to pay to get a solution that works.
Thanks

Good solution. Don't forget backups! Laptops are especially vulnerable (damage, theft, etc.