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I am in the process of opening a new practice on the Outer Banks of NC. This will be a solo practice. My set up will be receptionist, 2 exam rooms and my private office. I intend to hard wire this system. My question is what have you found works best, individual computers for each location or one main computer with workstations at the other 3 locations?

HIFM, welcome to Amazing Charts.

You will find many different answers to your question. The best thing is to assimilate from these answers a solution that works for your office.

1st of all, hardwiring is the way to go. You are thinking correctly here. This is always faster than wireless, and you don't have the same issues w/ encryption and security risk that you have w/ wireless. I have taken a hybrid approach. Most of my computers are hard wired but I have two lap tops which are wireless. If you have knowledge of how to secure wireless access points, then it's not a big deal. But if you do not know how to secure your wireless, then don't risk the security.

That being said, it is definitely BEST to have a central server and run your workstations off the server. Therefore your main programs (Amazing Charts and your practice management system) would run on the server and your clients would access their databases. This keeps your system running quickly, reliably.

However if you do not have the resources to buy a server or learn a new operating system (Windows Server 2003 or Windows Small Business Server 2003), then you should have a DEDICATED desktop computer that NO ONE ELSE WILL USE. This will be your peer to peer network.

You don't want a user on the computer that your main databases will be stored upon. It opens the door for system crashes and slows down your network.

In either case you will need another computer. Either a server or another peer to connect to your peer to peer. Keep your 3 other computers in the locations that you intend to use them in.

I hope this helps.

The answer really depends on how much money you have to spend and how much time you wish to dedicate to the setup of your office systems. I'll outline a couple of configs below that I know will work together.

For a budget of approx $5000, you can buy four desktops, related software, a network switch, related wiring, and a multifunction printer/scanner/fax. One of the desktops should be a dedicated "server" as Adam describes above. I would rely on XP Pro for the Operating system for all four of the desktops given this low end configuration. The drawback of this config is the scanner - a flat bed scanner is just too slow when you pick up the volume. Here is an example shopping list I did at Newegg.com to help:

https://secure.newegg.com/NewVersion/Wishlist/PublicWishDetail.asp?WishListNumber=5833545&WishListTitle=Amazing+Charts+Setup+%2D+Low+End

If you step up to about $8500, you can buy a network attached storage unit (NAS) to dedicate to the database, four desktops, a laptop for yourself, network switch with wireless g/n capability, related wiring, a multifunction printer/scanner/fax and a high speed scanner for ID cards, labs or records from other practices. I recommend buying a uninterruptible power supply as well in case of power outage and connecting to the NAS and network switch in particular. Here is the example shopping list I did at Newegg.com for this level:

https://secure.newegg.com/NewVersion/Wishlist/PublicWishDetail.asp?WishListNumber=5832865&WishListTitle=Amazing+Charts+Setup+%2D+Top+Level

You could purchase a server with some redundant components instead of a NAS as Adam suggests but this decision really depends on how much time you wish to dedicate to maintaining the system. A NAS requires less time, configuration and space to get it to serve up the database. However, a server has more capabilities that you could leverage as it has a full operating system (such as email, web server, ftp, etc).

With either option above you should have an internet connection at the office, preferably a broadband cable or DSL connection. This will allow you to easily set up a regular backup to a remote location using one of the products mentioned elsewhere on the forum (backup services like mozypro, idrive or carbonite). Don't skimp on this one - be sure you backup the data for your practice remotely and on a regular schedule.

With the shopping lists above, there are certainly ways to save money vs. buying all new. You could use ebay, build a system yourself, or purchase different make/models, not buy so many MS Office products, etc. It comes down to how much time you want to spend on the IT side of the business. Also, you could pare down the number of desktops to only 3 - one for receptionist, one for single exam room, and the other for the database. Balance saving this money though with the time you would expend.

Thank you so much for your help. I wish the sky was the limit on the budget but hopefully we can make it work with a good system. Thanks again!

Eric,
Question: Have you researched just how "HIPAA" some of these other off-site back-ups are? I would seriously consider one, but other than Jon's (AC's) because he as a doctor understands just how important that is, and what most of the rules are, I have hesitated to use anyone elses. Yet I would love to back-up other things we create in other programs besides AC this same way. Thanks

Eric is right on the money and said what I was thinking much more elloquently.

While a lot of users on AC use a Peer-to-Peer network configuration, I will confirm that a real Server-Client setup is much more robust and offers those functions that Eric mentioned (FTP, Webserver, company email). it also allows you remote access very easily and securely (however you can get similar features via www.logmein.com

I was Peer-to-Peer for 2 years, and in Sept 2007 went Server-Client. I used to have all sorts of problems with broken "links" to other computer's programs (like the office practice management software). We were slower and had no automatic backup or off site back up features. Don't underestimate the backup (until you lose your data).

I would suggest two other minor expense that will save you buckets of money:

1) check out www.onebox.com
Look at the Receptionist program, it's a very cheap answering service, $50/month. Way less than what I was paying a live-person answering service to do ($200-250/month), AND this connects the user directly to your cell phone, home phone, whatever phone. Also is a emai, fax, conference call center. It's ridiculous how many features it has. i've been using it since July 2007, no issues, not EVER. PLUS, no pager to carry around, just your cell phone and any other variety of numbers you can be at using the FindMeFollowMe feature.

2)You really should have a networked fax/scanner/copier. The expense will be a little more up front. However, the cost savings in toner/drums/paper will mount up very quickly. Since I've set up fax-->computer and computer-->fax, I can fax from any computer on my network, receive faxes on the server and never get a wasted cover page or aberant fax again. they just come across and PDF files. I went through one traditional fax and 2 "all in one's" before I came across the Muratec 1430 all in one. I thought I was saving money by going cheap up front, however I ended up spending 10 times the cost of my Muratec in wasted/duplicate paper-faxes, tone, drums, and staff time handling paper.

somethings to consider anyway....

On the question of which multifunction fax/copier/scanner to purchase, I agree with Adam that you should only purchase a version that can be networked. On my shopping list, I specified the Brother 7820N (N=networked). This one is at a much lower price point ($250-$300) than the Muratec 1430D ($1300-$1400) but they both appear to have similar features.

Here are the spec sheets on each so you could compare:

http://www.muratec.com/downloads/brochures/MFX-1430_Product_Sheet.pdf

http://www.brother-usa.com/VirData/Content/MFC/ModelBrochures/Brochure_MFC7820N.pdf

Key distinctions between the brother vs muratec include the sheer weight (20.9Lbs vs 48.7lbs), paper capacity (250 sheets vs. 1050 sheets), print speed (20ppm vs 14ppm), scanner and print resolution (600x2400 vs. 600x600). I found comparing the duty cycle difficult but this would be a major item to compare when shopping. Don't forget to compare replace costs of toner/cartridges.

I had difficulty finding independent reviews of the Muratec model online. Also, I couldn't find many online prices for some reason. I checked epinions.com, cnet.com, mysimon.com and amazon .com to no avail. I couldn't even find a "where to buy" link on the muratec website - the only way to find a dealer was to enter your email information in the "contact us" section.

Finding the exact rules relating to this on the HIPAA website
( http://www.hhs.gov/ocr/hipaa/ ) is a little time consuming but I did end up locating them.

Short answer is yes, these outside services do comply with HIPAA requirements.

The requirements can be found in the Security Final rule section of the HIPAA website:

http://www.cms.hhs.gov/SecurityStandard/Downloads/securityfinalrule.pdf

In the 49 page treatise there is a section on "Technical Safeguards" which describes the need for "Access control; Audit controls; Authorization control; Data authentication; and Entity authentication". Also needed for actual communication of data were "Integrity controls; Message authentication; Access controls; Encryption; Alarm; Audit trails; Entity authentication; and Event reporting". If you want to read the specifics, it is found around page 24/49.

Each of the external backup offerings meets the intent of the above requirements. Of course, it is incumbent on each practice to keep their ID/passwords private and not turn off the encryption features.

I use Mozy backup and, according to their website, it is HIPPA compliant
http://mozy.com/pro/hipaa