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I am starting up with EMR and looking at getting additional laptops or netbooks for office staff, I would prefer that they are inexpensive but quality. Do you have any sugguestions to which ones would work with AC, ie how much memory and how fast of a processor do I need to not slow us down?

Also, I have a second office which I will need to share info with. Any suggestions on whether to get a server or ? in order to hold the info from AC and have continuous access at both sites? How much capacity would I need if I have about 4,000 total active patients.

You will get a lot responses to this, there are many techno-savy folks on this Forum.
In regards to 2nd office, if your connection is fast enough, use a remote control solution (RDP, native to windows and LogMeIn work well for single user access. For multiple remote users you are going to get a little more complicate. LogMeIn has non-free solutions for limited multiple user, and and Citrix has a XenDesktop Express 10-user license for free.
Your remote access will let you keep a unified data base.
IF you are using LogMeIn or Citrix, the tablets (iPad, Xoom) become very portable and competitive (as well as fun)
Good luck

Thanks so much. I'll give Logmein a try.

Check out the recommended hardware requirements. Emphasis on:
1. Adequate screen resolution at least 1024 x 768 (especially netbooks with screens of 10.1" or less), since AC windows cannot be resized.
2. If you plan on more than 5 clients, on the main (database) computer you need the "Pro" version of Windows XP (up to 10 clients) or Windows 7 Pro (up to 20 clients).
3. Wireless networking will slow down access to the database, especially searching through Imported Items. Gigabit wired ethernet adapters will improve performance.

philg,

How many workstations are we talking? I need to know how many at the main site and how many at the remote site.

JamesNT

BTW Logmein ignition for the Droid is awesome for getting some basic info!!!!!

What is the deal with Citrix XenDesktop Express? I went to their website but only noted something about an evaluation copy which appeared to be for VM. Is there a free permanent solution through them. I know and use LogMeIn.

We'll probably looking at 5 workstations at the main office. Two at the satellite.

philg,

I just wanted to add that staying away from netbooks is a good policy in my personal experience as well as many of my professional clients. They are appealing from a price point of view and are very cute but lack power and have a short shelf life.

Gosh, 3 of the 4 in-room computers that I use at the office are netbooks. I love them (short of Dell laptops). They work just fine, with decent screen resolution and all have at least 1GB Ram memory. All have been upgraded to Windows XP Pro and my EMR is run through an 802.11g router. Two of them are Acers and one is an Asus. At home I use 1 more (an Asus). All are at least a year old by now...

Al,
Can you tell us more about XP Pro on netbooks? How did you install it? How much did it cost?....

philg,

While there are more than a few ways to do it as far as two offices, using a terminal server is likely the best way to go. LogMeIn is NOT an option as you cannot have more than one connection to the database.

What you may want to set up is a server housing the database with or without remote apps such as Word, etc. The remote office then has relatively cheap computers or dumb terminals which remote via RDP into the TERMINAL SERVER (not the server with the database). The TS allows multiple RDP connections and, since the TS is connected to the server, it allows multiple users to access AC or Word or whatever. The downside is you would want a server, and the TS license is a bit expensive, but you now have the speed you need as you are not transferring information across the Internet, just using the app with screen refreshes on your end making it appear that you are local.

I could be wrong but if you do open port 3389 (not a great idea) to TS, you wouldn't be exposing the server directly to outside attacks. If you had something like SBS 2008 on the TS, then you can remote in with extreme security as you would be using port 443 and SSL rather than port 3389 which the hackers know are for remote access. Of course, if you used SBS 2003 on the TS, you could use Remote Web Workplace which would be very secure.

So, in short, you would want:

http://www.box.net/shared/static/phec7ra11l.jpg

Another way is using WIN7 Virtual Machines on the server for each client at the remote office.

Let me provide you a couple of options, although neither one is run-of-mill.

One would be running two different commodity machines in the main office, and connect to them via VNC/Remote Desktop/LogMeIn, that leaves the work on the local network, as Bert has pointed out above. Additional cost, but perhaps worth it. As far as LogMeIn, as long as you are connecting to different machines, you shouldn't have any problems.

Another way to go is some beefer hardware, which you run as a virtualization server, and buy two semi-dead (or dead) computers with XP Pro Licenses, then re-use those licenses on the virtual server. You could choose either FOSS Xen or KVM, or you can go the Windows Hyper-V route.

A third, move novel approach would be dual-boot or windows tablets remotely connecting to the local network; you may find that is an option you would want to consider. If you don't like the tablet keyboards, wired or blue-tooth.

All off the beaten path, but doable.

Hi Jon:

I used an external CD-ROM USB drive (~$50, ebay) and used any of the multitude of Win XP licenses that I've accumulated over the years (I have about 30% more licenses as computers). I just upgraded the Win XP Home setup. In one netbook I had to reformat the drive and then download the drivers which was more involved, but not that bad.

Another upside of the netbooks is that I use them when I go on vacation, s.a. to London, England where I'll be in a couple of days. The netbook hardly weighs anything, has a long battery life (6 hours), and connects to any WIFI connection available.

If you wish to do speech dictation with DNS, you have to make sure that the CPU is the 1.6GHz and not one of the 900MHz models. You should have at least 1GB Ram memory, but 2GB would be better.

If you want to get REALLY TECHIE COOL, you can turn a netbook into a touch screen for about $80:



Pretty cool, huh?

The shelf life of my netbooks should be no less than that of any of my laptops. They are truly great machines.

Al

Bert:

>>> LogMeIn is NOT an option as you cannot have more than one connection to the database.

How about if each computer logging into the main office hooks up with a different node computer, which can then log into the backend server?

In my office I have 8 computers that I can log into- 1 paid (Pro2 account @ $5/month) and the rest are free. You can see the setup here:


















Now if you need to print to a local printer, just use their printer control:


















Not a bad setup for only $5.00... now THAT's cost-effective! Bert- although I use a www.box.net account, I don't have a "business" account which offers the "Box Sync" capability. Have you used this? Can it be used as a server?














Al

We use Dropbox for moving random file between our locations and remote client sites, I just set user permissions for each different folder, and it makes it easy to work without having to edit firewall configurations and setup Point-to-Point VPNs.

That would be another point that I forgot to mention about setting up a remote facility, a Point-to-Point VPN would allow you to print from a machine at the 'home' office across the VPN to a printer connected in the satellite office.

You could also prioritize VOIP, then VPN traffic above other traffic on the firewall/border router, and throttle lower priority traffic (music, FB, etc).

Program on client and data on a remote server requires a VPN and will not work. Data must be local because of the slow connection. Accessing a database over a VPN can result in corrupt data.

These are all good suggestions, but let me move back to the original question:

How to set up a remote office and use the host office. LogMeIn can only access one computer at a time. Yes, you can access several computers of which AC would be on, but then there are these issues:

-- First, if there are ten users at the remote office, there must be ten clients at the host office IF you want all ten to be active at the same time.
-- Each remote client would have to choose a host client, which would mean that this client would need to be available. Imagine a host user being logged off when the remote user tried to access his or her computer.
-- There are just too many variables in place.
-- Not to mention the EVERYDAY connections of LogMeIn, meaning, while secure, would still be using a 3rd party server which allows someone there to do something sinister.

Now, let's keep things simple. Let's have one Terminal Server (like a giant client but not being used by anyone at the host office. It allows multiple connections at once and would allow a very safe connection with RDC (if you are now using the new software that connects via port 443). The user at the remote facility opens his or her computer and clicks twice, once to open RDC/P on his or her compuer and once to select Connect. With a script this could be one connection. The connection takes about four to five seconds, rather than opening a browser, typing in a username and password (likely saved to be fair), choosing your client computer and logging in.

A terminal server setup is much easier to maintain as if there is an issue with a connection, there is one computer to go to.

VPNs are slower and can corrupt data on the host sever side.

Also with TS, you can continue to upgrade TS and the server so that you can add RAM or CPU, etc. on one machine, a machine designed for this exact thing, rather than having to upgrade individual clients if you want better performance.

I would like to place a vote for Bert and having a Terminal Server. That would be the best way to go. Lowest long term maintenance cost and lowest implementation cost.

JamesNT

Thanks James. Coming from you, that means a lot.

I am guessing that I haven't been sufficiently clear about why I would recommend a WAN/VPN would be specifically for managing remote printing and file-sharing between the two locations. It is fairly easy to implement, but not suitable for running AC.

Because I'm always up for learning things, I contacted Dell and CDW this weekend, and got them to quote Terminal services for an install as is being discussed. I also contacted the server specialist that we use to make sure I had the capabilities and licensing issues straight.

To be clear, we are talking about needing licensed PCs at the remote location, as well as a solution (with licensing) running AC in the main office. That being said, the major differential is the cost and effort to setup the main-office solution for the remote office.

As a stand-alone solution Terminal services were quoted within $64 by both providers, ~$1124. That gets you Win Server 2008 standard, and 5 terminal services licenses.

The other solution, virtualizing the desktops onto a VM server in the main office has a different cost structure. Checking the local CraigsList, you can get 2 used machines with XP Pro for approximately $100-$200; your market may be lower or higher. So if the hardware is useless, the license cost is ~$200 at the high end.

If we are talking about comparable hardware to run the virtualization/terminal server, the hardware costs are the same.

Everyone's services costs and providers are going to vary, but we typically charge about the same for either a WinServer 2008 or a Xen/KVM virtualization server install, so again that is a push from our perspective.

Support wise, if both machines are doing automatic updates, I'll stipulate that both will run through the first year without much interaction.

One of the reasons that we increasingly suggest virtualization of desktops is the ability to replace the virtual desktop at the speed of a partition copy. It obviously *shouldn't happen*, but users can bogger up desktops, and being able to remotely re-create the instance in a matter of minutes is handy.

So, at the end of this intellectual exercise, the license cost is ~ $925 more for the Terminal Server solution.

What I can't price out is the hourly rate that Doctors are going to value their time at installing/configuring/maintaining one solution over the other. Over time, both will run undisturbed.

In having seen the breath and depth of technology exhibited on this board, I would think each solution could be DIY'ed by the folks here, it just depends on what they want.

Indy,

I agree with everything you said and well said at that. The only place I would disagree is the DIY part. As you astutely point out, what is the hourly rate that doctors value their time with installation, etc.

I would maintain, that even though using a TS is not an extremely difficult proposal, I think if you have to leave the building to get to the other computers, they would be better off hiring someone who does this for a living. I would be willing to bet that the ten or so users on here that have asked how to set up a remote office would have some measure of difficulty understanding your post as well as it is written.

Depending on the support contract, e.g. hoping to get a pay per encounter one, it would help to be able to contact that support if they were the ones who set it up.

Bert,

From my perspective, most Doctors are probably better off seeing patients and leaving the software tinkering to folks who do it for a living; but that is a economic efficiency argument, not one based on the capabilities of this crowd.

I specifically frame how I express things generally as a DIY discussion because, 1) I believe that it is within the capacity of many of the folks here, 2)I do not want to give the mis-impression that I am advertising.

Besides, running down the latest pricing, licensing rules, and hardware capabilities is always productive if it will help more folks by publishing it here.

A question about terminal services:

I've been using LogMeIn to access AC on my office computer, from home. Seems to work fairly well. The one slightly annoying aspect is that the screen resolution isn't perfect, and more importantly, the screen refresh speed is variable but at times slow.

My question: does terminal service access provide a consistently faster screen refresh?

I doubt I would want to plunk down $1,000 for a better connection at home, but still curious.

Thanks

Michael Jacobson

I will answer your questions when I am not so tired, but basically you are not using Terminal Server for a better experience. You are using it so that you can have multiple remote connections.

While there have been changes both in name as in Remote Desktop Protocol to Remote Desktop Connection, the idea is still the same in that Windows provides terminal services to allow remote connections. In past versions of Windows these connections were made throug port 3389 unless changed. As an aside, port 3389 is always open (once opened) and is THE port for hackers to attack your system. With the advent of 2008 Servers, RDC connects via port 443 (HTTPS) and is therefore SSL and secure. But, basically, RDP connects to a remote computer.

This connection has always been one to one. RDP from a remote PC to a host PC. You could only have one connection at a time. With a TS, you can have multiple connections and many other network settings can be employed. Users can access applications and something knonwn as RemoteApps. Remote apps allow the remote user to remote in to a single app such as Word as if it were on his or her machine without even logging into the complete desktop.

More later....

Indy, I agree with your last sentence, but I have to disagree with its being an economy vs DIY issue. Most people on here including myself are not capable of doing a lot of the things talked about on here. An ounce of prevention is worth a pound of cure is the cliche that comes to mind. I have spent many late nights fixing, usually via Experts-Exchange an issue with my network or server because it wasn't set up correctly in the first place. If I had know the initial complexity of setting up a domain correctly, I, myself, would have hired someone. A lot of that was because I didn't think IT was available in northern Maine.

But, I digress. I suppose it isn't completely fair to simply say, if you have to ask, you shouldn't do it. I have asked many people many times to get the answers I needed. But, I think that as time goes on, I more and more know who to ask and where to go to get those answers. I do not think there are that many people on here who know how to set up a client/server domain which utilizes Terminal Services.

Again, I am in that majority.

Bert,

Thanks. I did understand from your previous posts that terminal services allowed multiple users to remote into one server, which would make it a solution for connecting a remote office location to the main office, for example.

Given the ability to tailor what the remote terminal can do on the server, I was just wondering whether terminal services could also be a bit faster / more efficient than a conventional remote desktop solution like LogMeIn. Sounds like that's not the case.

Given the slight screen refresh delay, it seems to me that the experience of working remotely would be a bit annoying in the long run if it's exactly like LogMeIn or other remote desktops. Then again, maybe LogMeIn isn't the fastest remote desktop solution.

Michael

Has anyone tried "Teamviewer.com"?

gee. $749 is a lot. But it is a lifetime buy. $20/month for 3 years is getting close to it anyway.

philg,

Teamviewer would not be a good solution. It is a commercial app that, like Webex and GoToMeeting or GoToAssist is designed for support purposes.

Say you call Microsoft, Symantec or even AC support. They have purchased a lifetime license to one of the above programs, although as far as licensing goes, I am not sure if they all have lifetime setups.

So, most of these support companies have the ability to log in to your computer and fix the problem. This is what Teamviewer is for. Obviously, it can log into your computer from home, but you do not need this.