Home Forums Discussions General Discussion AC in multiple offices

What is the best way to use AC in more than one office while keeping one data base?
I appreciate any input?

Hang around a moment,and I will explain.

Mohamed,

There are two general architectural approaches, but each one is going to require reliable and usable[fast-enough] Internet to make it possible. How fast depends on your several factors.

One is to have a main/base office with the secondary location - server is in the main office and the secondary office connects to the sever through a variety of means.

Second approach is that the server is provided on the Internet behind a firewall, and each location connects to this central location. Again, lots of options there as well, the first being if you want to DIY, or use a service provider.

Bert and I can both elaborate further, but those are your top-level paths to support both (or more) locations on one database.

[Disclosure - we have a business unit recognized by AC that provides services in this arena]

Indy
Thank you for your quick response. Would you please elaboate on the fisrt option. My main PC connect to internet by DSL.

Mohamed,

Indy has given good answers and, in fact, suggested one that I had completely forgotten. The easiest approach is using the cloud. AC now offers this, although maybe a tad pricey. Indy's company also has a cloud solution that, as he said, works with AC's blessings. If you can go through Indy, I think you will find you will get excellent support, something you will want if you use a cloud solution. In fact, I would recommend talking with Indy directly (if I may be so bold as to offer your services, Indy).

The other approach if you want to keep things in house is terminal services. While some non-OS can use TS, you are better off using a 2003 to 2012 server OS.

You can use the server you have and set up the role for Terminal Server. This will allow the remote computers to act as terminal clients and access the application or apps remotely and concurrenly. Since, they access in a way so that you are only sending key strokes and mouse clicks and viewing the program on the server, it can be very fast. As Indy says, it is Internet speed dependend. You will find that T1 speed is sufficient depending on the number of users. Certainly, cable and DSL can be much faster, but keep in mind that those speeds can fluctuate.

Each of your clients will require a separate CAL to access the terminal server. Although, you usually get a 120 days trial.

Now, most IT will recommend that you use a separate terminal server as the server with the domain controller should not be used for terminal services. Many OS packages such as SBS 2008 Premium or SBS 2011 Standard and others will come with an extra OS, which is perfect for setting up terminal services.

So, here is what it would look like. You would have the host network being managed by a server with a server OS running as the domain controller just like normal. You would then run another computer/server with a server OS that would be solely used for Terminal Services. Then, using Server Manager, you would turn on the Terminal Server allowing you to set up remote client services, and each computer in your remote office would then log onto the terminal server. The terminal server would recognize the connection and would set up a terminal session allowing your remote clients to access any software or databases installed. This setup allows multiple connections to run concurrently. Not to get too technical, but as the admin on the host network, you would be able to monitor and control sessions on the terminal server.

This is the way one thinks when talking about a terminal server and remote connections. But, having a terminal server allows other advantages on the host side such as accessing programs on the TS remotely using RDP. So, each client, while working normally and working as a client/server app to the main server, may require access to an app that is only on the TS. They could then remote to it using RDP without any CALS.

The only thing I haven't mentioned is the need for Servers and not peer-to-peer. While we have argued this ad nauseum as far as the basic setup and I agree that basic OS such as Vista and WIN 7 are sufficient, if you are really going to set up a remote office, then you really need to invest in the proper software and hardware to do it correct.

Hope this helps. Let me know if you have any questions. Of course, Googling Terminal Servers will give you 1,000,000 hits. But, it isn't always straightforward. Plus the terminology can get vague with Terminal Server and Terminal Services, etc., both of which are the same, yet different.

A Terminal Server is only necessary if both office locations are open simultaneously.
There's no need to buy a terminal server if only one office is open at a time.

A few things might make things easier.
1. How many users do you have?
2. How many people are at each office at a time?
3. Do you have an existing server?

To make things simpler. Microsoft Offers preconfigured solutions for both roles. You can get SBS 2011 Essentials ($400) and MultiPoint Server 2011 ($450) + CAL Cost for each.

Server 2012 has also hit the market and can be configured manually. You would only need to buy that for $810 plus the price per RDP CAL. But you are likely going to pay a lot for the configuration.

IMO Option 1 would be much better depending on your tech level. I would also advise virtualizing this on one box to save some money as well as simplify management.

I'm not sure if I have to add a disclosure...

Bert/Indy/Sandeep
Thanks for all of you I appreciate your feed back. However, my problem is my knlowledge about computer networking is Zero. I do not undrestand most of your technical term. I looked into AC in the cloud; it is pricy. This not an option for me.
To answer Sandeep questions; I will use one office at a time. I am the only user, in addition to my nurse and the front desk person. I have no server in my office.
Is there any way to use a lap top and synchronize with the main PC to start with? What about networking with logmein?

Synchronization is often not recommended even by the AC Staff.

Another recommendation would be to have a dedicated computer for Amazing Charts and SQL.

There is no need for a terminal server in that case. LogMeIn is one option, but Remote Desktop is recommended. If you did use LogMeIn, you would likely want the pro version which is ~$70 per computer per year since that is the only way you would be able to print at the other office. Remote Desktop is free and lighter on the bandwith usage since you mentioned you have DSL. Furthermore, it's built into windows.

Remote Desktop requires the Professional Versions of Windows. If you don't have that, there are ways around it, but not recommended...

You have two options
1) Set up Remote Desktop/LogMeIn for each computer individually. Remote into them from second office. LMI also uses HTTPS authentication.
2) Get SBS Essentials and use the remote desktop gateway. This would require having a separate server/main computer which is always recommended. It's also more secure as it uses HTTPS authentication.

Do you have computers in both offices already? If not, there may be a more cost-effective third option.

Really, he would only need 1 or possibly 2 computers to remote into, so this is NOT that difficult.
This SHOULD NOT be the main computer, reserve that only for hosting AC.
He could logmein all of his computers but only reserve 1 or 2 for pro. This would allow access if needed. LMI is free for basic.
Ignition makes it VERY quick to log in, but then RDP is quick if you have a static IP address. Both seem quicker than using SBSE remote access.
I'm curious about the other option.

Sandeep/Wendell
I am planning to have another office about 25-30 miles away by January 1st 2013. I do not have any equipment yet I am just trying to make plain. I will definetly need 3 PCs in the new office . One for my use and one for the front desk person and a third PC for my nurse. Now the question is do I need to dedicate any of this PC as main PC to use logmein? I already have logmein pro for one of my PC in the curent office which is not the main PC now. What do I need to to get from logmein to use in the new office? Logmein central, pro, Hamachi or Remotelyanywhere product?
on wich PC should I use Windows professional and SBS essential?
Please excuse my ignorance a simple straight 123 instructions
Thank you very much.

No, you do not need to dedicate a particular machine. They are all connected. Again, do not use the "server" as the LMI machine because you should not be using it as a desktop machine. Too much at stake.

OK, logmein can be installed on any and all computers. The FREE version does not allow printing, quick desktop shortcuts, or moving files. Most of the time you do not have to have those features so having 1 or 2 pro machines (primarily to print) would be sufficient.

LogMeIn Ignition allows you to rapidly open computers both free and pro. I forget what the annual cost is but it is low and covers the account regardless of how many machines it is loaded.

Central will keep up with updates on your computers and overall health but is about $150 a year as I recall. I did not need it.

Hamachi might work but will probably be too slow. There may be other remote networking things out there but I cannot comment at this time.

Remotelyanywhere I cannot comment, don't have experience. Ithink it is more if you are logging people in to do repairs.

SBSE will allow you to log in to all the computers on your domain. Costs about $400 for the program over the cost of the machine, installation and setup. You log into a central website and from there pick which computer to remote desktop into.

I use logmein (with ignition) between my two offices, but I have each office on a separate database and only log in to sometimes chart, sometimes look up information. Every computer is on LMI, I have 5 pro accounts (got them on sale)

Staff has dedicated machines they can log into when they need to make appointments or look up information. Some patients have charts in both offices. I also use LMI to support the various computers.

To be continued...

We use several LMI services on our tech services side, but LMI Central may be over-kill unless you are changing configurations much.

I agree with Wendell that Ignition combined with LMI Free is *very* effective. Fast, single app to click on easy. Your staff will appreciate the ease-of-use.

Buying three copies of Ignition and being done with it will be far faster with less moving pieces than implementing SBS or another server that you then need to maintain.

That said, then things that you then focus on is the Internet providers and the network performance. When I read DSL, I wince from years of iffy client experiences. I am thinking I need to do a Physician-friendly blog post on measuring network performance so that you can anticipate what the performance is going to look like.

One of the things that practices do (which we recommend) that use our managed servers is having a back-up plan for if your Internet provider goes down. With 4G/LTE phones, WIMAX, fixed wireless, you have options.

So either way you'll need 3 computers at each office. If you do not have the Professional Version of Windows at the current office. I strongly suggest you get it on the new ones you buy. You'll want the ones with professional at the main office (where the main computer is.)

What everyone suggests is to load LogMeIn on each of those 3 computers at the main office. Then remote into them from the second office. That's about it.

I think Remote Desktop would be better. Enable remote desktop at the main office and remote into it from the second office. I would recommend doing both LogMeIn and Remote Desktop to see which one you like more.

Personally, I've found Remote Desktop to run much smoother even when the internet is very slow.

This was the question. The question was not, "How can I log in to computers at my other office. Wendell's suggestion of using LMI works for him because he uses TWO databases you stated one.

If you can set up LMI (takes 30 seconds) at home and log into your computer at work, that's great. That is what it is for. It is NOT for connecting two offices.

You asked how to set up a satellite office so it connects to one database. That is both easy and hard. But, you can't do it correctly by logging into several different computers on the other end. S = Satellite computer. PC-S1 can log into PC-H1 but only if there is no one using the host one computer. And on down the line. From what I am reading above (and I may be reading it incorrectly), the scenario is this: Imagine my setup. I have 10 client computers connected to one SBS 2008 computer. If I set up another office with three computers, how are they going to log in? Are they going to log into the server? They could if TS was set up. But, no one in their right mind will let other users log into the main server. When I said domain controller, sorry. That just designates the actual server that your office runs on. A TS is separate.

I know that my first answer got too complicated. But, then you would have asked what is a terminal server, etc. To answer the above question, they would have to log into a client machine that is connected to the server. Great if no one is on that computer. Great if that computer is on. Great if everything is working with AC, etc. Try this experiment. You could do this at work but to make it a better experiment, go home and use LMI or RDP to log into a computer someone is using and see how happy they are.

Basically, most are saying you can log into various computers on your host network and connect to the database. That will cause issues. If you have five computers on your host network, the users at the remote office will have to log into one of those computers or the server. Why not have just ONE powerful computer to log into that is made for this type of setup. Now all five of your remote computers can log into the terminal server until their heart's content. You also can put AC on there or office or whatever.

Look at it this way. Sorry to give so many scenarios. You have your host network with five computers connected to a server. You could enable terminal services on the server and log in there. The ONLY problem is no one wants to have their main computer being used by remote clients. Solution. You add one more server. That's all. Get an HP ML110 for $1500 and add the second OS that Sandeep and I mention.

You mention you want 1, 2, 3. It is easy for an IT tech, but it isn't 1, 2, 3. I say this all the time, but if you have to ask, then you need help. This is your patient data. Don't screw with it. Get a professional who will give you all your options and tell you I am crazy. Go to Google, look for Microsoft Certified IT Professional and MVP and pay him or her to consult and set up. It will be the best investment you'll make. I guarantee you, you can't do this by yourself.

My answer to you is either cloud or something like Terminal Server. Your question is a good one, but when this question comes up, two things happen. First, this is the most challenging thing to set up for a beginner, and two, the asker wants a simple answer. It is simple but only if you are somewhat skilled in networking.

Questions such as DSL vs Cable vs T1 or even T3 have to be looked at. Do you have a backup plan if your Internet goes down? What access do you have to your IT. I mean Microsoft IT, not the infamous IT guy down the street.

With TS and what Sandeep mentioned, your users would turn on their computer, click on RDP and be in TS and with their session running, they wouldn't even know it wasn't on their own computer. Why not RDP into one of the clients. You can if it is not in use. But, TS will allow multiple, concurrent sessions.

Yes, if you go with a Terminal Server (which I am assuming both offices will be running simultaneously unless one is open in the day and the other at night). It will cost you an extra server, OS software and CALS. And, it will DEFINITELY cost you an IT person.

I have a friend in Canada who has been doing networking for 35 years. Strictly Microsoft. He is always blown away by the fact that doctors do not want to invest in their networking when their entire patient data is at stake. His analogy, which is obvious, is if you told your a patient that you were worried about pancreatic cancer and recommended an MRI (sorry if it is CT), and they opted for a plain film, you would go nuts.

What I am talking about is two offices using AC, finishing a note, and all the data seamlessly being saved to the same server.

Bert makes a lot of valid points. But the main point is that he said only one office will be open a time which kind of makes a terminal server unnecessary:


From the information given, I can't see the use of a terminal server. I would say go for the terminal server if there were no computers at all in both offices. But since he already has 3 at the main office. He needs three more at the satellite office. Each person remotes into his/her own computer. No one should be on the other side.
Main Computer which no one should be using. No one remotes into.
Salem remotes into Salem's computer at main office
Nurse remotes into nurse's computer at main office.
Front Desk person remotes into front desk's computer at main office.

Terminal Server would be necessary if there were people at both offices trying to work at the same time.

I agree completely. Missed that piece of information. My recommendation of a terminal server would be if both offices were open at the same time with multiple users.

I will give one caveat, although it's not worth the cost of a terminal server. (Mohamed, when we say terminal server, we are simply referring to a computer -- hopefully with good hardware -- and an OS that you enable Terminal Server).

On Wednesday mornings, I have a nurse practioner. Each person has their own computer, and like me, the NP has three that she uses. I am at home and need to do a little housecleaning before I come in. Given that my computer has performed its nightly crash, I can only log into the server. Which I do, and I cringe. Of course, I could log into someone's computer and ask them to turn mine of.

One thing that always kills me, though, is any time I remote into someone's computer and it asks them to allow it, they freak out and kick me off. AARRGGHH. Of course, this is not a good reason to get TS. You may as well just have another computer. Then again, may as well use that other computer as your own.

Based on Sandeep's updating me on the correct info, Wendell's suggestions make more sense.

Bert/Sandeep/Wendell/Indy
Thank you all for the valued information. I learn a lot from all of you . At the begining it was for hard me to know what are you talking about. I did not know what is Remote Desktop, what is ignition with logmein or LMI means. I think I got it now. both ideas, either with remote desktop or logmein pro with ignition seems simple and straight forward. Since I am not starting the new office now, I will experiment with Remote Desktop between my home and office PC. I hope I can set it up correctly. I will report back to all of you in the next few days. Thank you sooo much.

Your welcome, but Bert made a definite point. If you aren't comfortable with what you are doing, you probably need an IT person to help you.

Servers (Terminal or Small Business Server Essentials (SBSE)) usually require an IT to get it right unless you are willing to undertake a moderate learning curve. Even then, IT support will guide and teach you along with other resources.

RDP (remote desktop) and LMI (logmein) are fairly straighforward, but may be somewhat slower in logging in.

Indy's point about having good internet service and a backup is also valid. I started with two offices with different databases about 8 years ago because it was not practical to do it another way. Now I'm not so sure, but I have more reliable internet than I did then. I don't have a backup 4G (cellular) service, but they can be affordable on a pay as you go plan and with work in a pinch if your internet goes down. If it's down, you cannot chart or send e-Rxs. Very frustrating.

Even now I have had occasion to log in and see that all the computers on one side or another are red (in Ignition) leting me know they are not connected to the network. One time, Comcast had to replace 2 modems and rerun wires over about 4 visits and several months to straighten that up. Not a major problem because I had a system at the other office and now have duplicate patients scattered between the two offices. That is

Mohammed,
I have not responded to your questions because you are getting a lot of good advice from very smart and knowledgeable people. I am answering now because I have been in exactly the same situation as you, and can tell you what works for me. I will keep it simple.
The advice above is good; some of what I will say has already been said by them:
1. Go to logmein.com and create an account.
2. Download the program (just logmein) on each of the 3 office computers.
3. Sit at your computer in the office and open your browser. Go to logmein.com and log in. You should see a list of the three office computers. Select one of the other computers in the office and click on it to connect to it.
4. Spend a little time playing with AC on the computer you are "visiting" (opening charts, etc). This is just what the staff member will experience from your other office when they log in.
5. Go home on your home computer, open the browser, go to logmein, and this time, connect to your own office computer. This will be exactly what you will do from your second office. If it works (it is fast enough, easy to see, no dropped connections) then you are ready to use it in your new office.
6. Notice that at this point you have spent NO money. This may not be the BEST solution, but if it works, it is certainly the cheapest and easiest.

See how that works for you and report back. You can do the same thing with Remote Desktop, and see if you like one better than the other. When you report back to us, we can help you choose which program to use, and whether or not you want additional features like Ignition or Logmein Pro. You will probably want to come back here before buying new machines for the office, if you have not done so already.

Jon
Thank you for your input. I appreciate you trying to simplify things for me.
I am familiar with Logmein. I use the pro version on one of my PC in the current office . I use it to log into AC and sign charts and review my schedule. It is a bit slow . I learned now about ignition can speed up the process a little bit . I have not tried it yet. I would like to try Remote desktop. Sandeep indicated that might be faster. I am having trouble to get it set up between my home PC and my office PC. I will find an IT person to help then I will judge which one is better.
I am still looking for a new office may be will take another 2-3 months. I am just trying to make plan.
I just wanted to know your own opinion , is logmein good enough for you? If not what are using now?
Again thank you very much for your input.

PM me and I can help you set it up. Should take a few minutes assuming you have the router password handy.

I have the same experience on occasion when I use logmein I got disconected.
This is why I wanted to try Remote Desktop to see if it is diferent. or as a back up as Sandeep suggested. I Like your suggetion of using a 4G (cellular) service as a back up for internet connection. I am still looking for an office space . I realy do not know what type internet connection I will have. I am hopping it will be a cable connection which is more reliable. I could change my AC data to the new office insted of the current location with DSL connection.
Any how at least I have two simple solution to start with.
Again thank you very much and I reprt to you back as I said.

Sandeep
Do you mean the router passward in the office or at my home? I also do not know the name of the PC or dull adress. Tha might be a problem too.

That's fine. Just check the message I sent you.

Mohamed,
I do still use logmein. I find that it works well for scheduling, putting in demos, signing-off labs and documents, etc. Doing a full note is sometimes a bit slow, but I still often do it. Let us know if you find RDP to be significantly faster.

I will, thank you again for your help.

I have thoroughly enjoyed the conversations I've been in with doctors where they yell at me for how expensive the $1200 laptop or $900 workstation I'm recommending is as they walk past the "Copay due upon arrival" sign in their office on their way out the door to drive away in their BMW/Lexus/Mercedes.

JamesNT

Or their 1981 air cooled Vanagon-
Sorry Mohamaed but I could not resist.

I agree with James, and by the way, I had a BMW and now a Lexus, lol.

Mohamed, what would moving your data to the other office accomplish?

So we got Remote Desktop setup. AT&T's router interface is a bit on the strange side, but it's done. No we wait for the home test.

He would have a cable/broadband connection on the other side which typically has a larger upload bandwith compared to DSL.

Anyone think outside the box and use a laptop as the "main" computer where the database resides and take that computer from office to office. Have the desktops connect to the laptop while in the office. Run a backup to one of the desktops before leaving and then take the laptop to the next office.

Fresh backup available in case something happens to the laptop and simpler solution for small office with one doctor.

Greg

Taking a flash drive from office to office might even be easier than that with these new USB 3.0 drives you could restore the database swiftly. The issue is with efficiency and simplicity. It's much easier to simply click an icon on your desktop and have access.

Things could get ugly if that laptop got into the wrong hands. Sure the database is "encrypted" but the Imported Items are easy to open. There are measures you could take, but that would just make things more inconvenient. Same reason we have automated backups among other things.

I think it could be a brilliant idea. Just have to think it through. All of the answers have flaws.

But, I suppose I could see leaving it in Office A, then driving 30 miles south which is five minutes from Office B, then realizing you have to back.

Then, again, you could just LMI to it.

The main issue with VPN is throughput and risk of data loss on disconnect. The main issue with transferring physical machines is convenience and liability. I sort of see Terminal Server/Remote Desktop/LMI as a balance between the two.

You could get a dual WAN router at both offices to ensure uptime and reliability. Maybe use a cell phone as the second WAN or in case of emergency. That's when you definitely want to use Remote Desktop because LogMeIn needs more bandwith.

Bert
The reason I mentioned the possibility of moving the main Database to new office is the internet connection. The current Internet connection I have is DSL.
I am hoping in the new office it would be a cable connection wich is more reliable. Second If am bying a new equipement I will use a better machines and a windows professional and may be windows 8.

msalem,

I would advise you to steer away from Windows 8 for now. Windows 8 is an entirely different beast than Windows 7 and may include a bit of an unexpected learning curve for you.

Windows 7 has years of support left, so you are all set.

JamesNT

Jon/Wendell/Bert
I was able to use remote destop connection for the first time to access my office PC from home. My first impression;it is faster, have better resolution and better for typing notes and message as well as signing imported items.
I think with the combination of logmein as a back up a second office for a specialist could be simple and convenient for a solo provider like me. I will move from one office to the other with my team. Phone call can be forwarded to where we are at that day. I still need to try ignition with logmein.