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Hi, I am new to the forum and would appreciate the help of the community. We are tech simpletons, and are hoping for explicit hardware brand/model/spec advise in very plain language! Allow me to give our background first, because it might be relevant: we are 2 pediatricians, planning on getting AC. We are part of a large multispeciality group affiliated with a hospital ACO, and as a result we have to use EPIC for practice management/billing/scheduling. But the 2 of us have the option of using our own EHR separate from PM, and we are drawn to AC over EPIC for EHR for its ease of use. In addition to our main computer, our office would have 7 local computers, 2 laptops for the docs, and 3 laptops or tablets for staff. Our goals are ease and efficiency in a high volume practice, and to minimize technical problems and long term costs.

We are tech novices, but we are persuaded by Sandeep's forum entries to use server hardware (for ease of repair and protection against power/hardware/memory failures). We are willing to pay more for our main computer and other upfront costs if it will make us faster and causes less time/money/tech headaches in the long run. However, we think we should have a P2P system (not a client/server domain), because it seems simpler and easier to troubleshoot, it seems it requires less IT support, we don't plan on running a lot off the main computer (just AC for EHR, a scanner, and someday a fax and patient portal). Does our plan sound good?

OK, given our situation, the following are our specific hardware questions:

1. Main computer with "server hardware" (but not client/ server domain): Please make it very easy for me by providing very specific suggestions for brand, models, and specifications (e.g. processor, RAID array, RAM, solid state drives, memory etc). Also - where should we buy it? Will a main computer with "server hardware" (but not client/ server domain) require IT support to set up?

2. Laptop -- I am concerned about screen size, my eyes aren't great. Hardwired wouldn't work well with our exam room layout. Please recommend specific laptops that would work well for AC with our setup. Given my concerns about screen size, do you have any thoughts about wheeling a computer cart with the laptop connected to a big screen from room to room, the way they do on hospital floors? Or maybe having a large computer screen on a small table in each exam room, and plugging my laptop in each time? Would tablets be better than laptops for staff, and if so which one?

Many thanks.

Larry

Hi Larry,

Welcome to AC!!

Regarding laptops,

http://amazingcharts.com/ub/ubbthreads.php/topics/62508/Laptop_for_EHR?#Post62508

is a recent discussion. You will notice there are not many specific recommendations. As I mentioned in my post, I have been extremely disappointed with my new Lenovo ThinkPad, both keyboard and mouse pad are very imprecise.

I think an i3 processor would be adequate, i5 would be desirable. Based on my experience, I would probably buy HP now.

I carry my laptop, I do not use a stand/cart. I turn the screen to face the patient when appropriate (to see an xray etc) and away when not appropriate.

The thread also references use of Chromebooks. Jimmie is the master of these, he has adapted these very well to his practice. When he started posting of his successes, I purchased a Chromebook. I found the screen very small, and the interface cumbersome. The work to set it up and use it seemed to outweigh the cost saving.(This is probably far more a comment on my lack of technical ability.) I would prefer not to have a larger monitor on the wall of the exam rooms. (I don't want patients to see everything that I am viewing.) So, for me, the Chromebook is an experiment, tried and failed. However, Jimmie is doing extremely well with his.


Regarding server and operating system, as you found, their are many threads about this. I have used peer to peer for the last nine years. However, due to back up considerations,HIPPA considerations, and so forth, I think it's finally time to go with server, not only hardware but also operating system. We are ordering this from Sandeep, his price is extremely competitive and he will do all the set up remotely. The server is a Lenovo TD340, Sandeep is setting it up, I believe, so that it could probably run Amazon.com or eBay.

Again, the peer to peer versus server debate is ongoing. If I were starting fresh, I would definitely go server.

Good luck!

Gene

@Gene,
I appreciate the mention and kind words!!!!
@Larry,
Good luck on your endeavor!!!

Larry,

I would recommend considering a chromebook paired with a chromecast for each room.

We have been a proponent of Chromebooks as a cost effective alternative since their initial release, and it is gratifying to see what folks have been doing with them. Jim[mie] has put Montana on the heath-tech map with his innovations.

Chromebooks wake up in seconds, can run just about a full day without charging, have a much lower attack surface, and you can control when they 'cast' to the wall-mounted display. You can easily walk in and out of the room with it, so that it isn't laying around for idle hands.

The other aspect is if you use the remote desktop connection on the Chromebook, you get far better performance than you would with a laptop that is running a client.

Even if you have a Chromebook as a spare, putting one into service takes less than 5 minutes, whereas prepping a laptop to make it useable can take the better part of a day.

Indy,
Thanks for the mention!!
It is your darn fault for giving the idea for the chromebook to Lisa in Laramie in the first place!!!! Who knows what I would have ended up with for a Christmas gift.

Jimmie,

Glad to be of service. Part of the reason that we do meetups is that amazing things come out of them. Ideas, new innovations, new businesses. Good stuff.

Saw this on the enterprise side and wanted to share it:
http://www.informationweek.com/mobile/mobile-devices/chromebook-sales-surge/d/d-id/1297921?

"Sales of Chromebooks -- mostly portable devices running Google's Chrome OS -- are expected to reach 5.2 million units in 2014, according to Gartner. That represents a 79% increase from 2013. By 2017, the research firm predicts, Chromebook sales will reach 14.4 million, nearly triple the current unit sales. That's about 2 million less than the number of Mac computers that Apple sold in all of 2013."

So Gartner (premier tech forecasting org) puts Chromebook sales close to all Mac unit says by 2017. Not bad growth for a platform.

Team it with more display options, and the task performance of remote sessions, and it is a valid alternative.

I have been tweeting too much lately, I was looking for the retweet button to pass your message along!!!

For Server:

Dell Entry Level Tower Server (PowerEdge T620)
Single quad core processor.
8G of Ram
Two 146G 15k rpm SAS hard drives in a RAID 1.

For Laptop:
Dell Latitude 15 3000 Series laptop should more than suffice. http://www.dell.com/us/business/p/latitude-3540-laptop/pd
Go for the MID RANGE. Don't get the cheap one. You really want an i5 processor.

JamesNT

That's a good move to use server hardware. The upside of a server is really the Operating System though. It just makes a lot of sense to use it. For example, Server 2012R2 Essentials can handle remote access, domain users and groups (essential for security), remote web access, server backup (as well as a backup of every other computer on your network), VPN, reports and monitoring via email, fax, and much more.

The increased complexity stems from people trying to do more than they would normally do. Obviously there is more of a possibility for issues when you see all the stuff it can do. But the reality is you would've never had those abilities if you didn't have the server OS in the first place. A lot of people mention issues with the security groups and stuff like that, but if you look at P2P. Most people just allow Everyone access to the AC folder meaning anyone can get access to it. You can do the same with a server, but why would you want to? You have centralized user management so you make an account on the server and that person can log into every computer on the network rather than making separate accounts, folders, files, shortcuts, etc. Disabling access is extremely simple too. I might so a web series on this if people are interested.

It's also good look at new technologies with virtualization. Replicating servers can be had for very affordable prices now. You can use any old desktop or a used server from eBay.

I'm going to have to disagree on the server recommendation by James.

146GB is not enough to host the OS and Amazing Charts. We have people with 100GB+ of Imported Items on our backup plan. We have seen lots of cases where people did not have enough space for Windows Updates despite following the MS recommendation. I would also look into using solid state drives over hard drives. There's lots of data supporting the reliability of SSDs and not just from the manufacturer/vendor.

It's been a crazy week and I have not logged in for a few days.

A lot of your network setup depends on your physical structure as well. Laptops are OK, but more prone to theft and more likely to use wireless, which is both slower and less secure than hard wired. Hard wired, on the other hand costs more money. I'm not saying that wireless isn't adequate, it's just prone to be not as good.

You might benefit from spending a few dollars on an IT consultant to get some recommendations using all these responses as basic information (and they should know AC preferably or at least EMRs well.)

P2P vs Server Client (S/C): P2P can be as secure but requires each machine to be set up separately and then reconfigured with any change. Servers require somewhat greater knowledge but not great to manage the users. For an office of about 6-7 people P2P can be adequate. S/C can force default setup for best practices including periodic password change. While this can be done without fully setting it up as an Active Directory, it almost becomes easier to do.

That said (about P2P), I might still go with SBS 2012 Essentials Server. It gives you good remote access and can be set up to both monitor and backup the other machines (as well as host AC and a host of other things.)

Hard drive size? Starting with 146 may be OK, but will depend on how quickly you fill it up. Larger is better. Scanning efficiently will help to keep your import items size under control.

Memory 8G seems somewhat small. I have seen SQL sucking almost 3 gigs (on top of server services and any other programs) and feel that 16G would give you much more head room.

Machines: I like desktops and a large screen. Jimmy's setup with the wall mounted TV seems promising and I may go that way in the future, but a 21-24 inch desktop screen is sooo much better than a 15-17" laptop screen. Again, hardwired is better, and desktops are set up for that. Hardwiring costs more money.

I hardwired my office and run desktops (intel i5s) in all the rooms, front desk, and nursing station. Also two monitors per desktop!!! Everyone loves that: me, my team, and the patients. I have a gigabit switch and a separate one with PoE for the VOIP phone system.

I'm on a Server/Client Environment with SBS 2011 on a RAID 10 and AC on a RAID 1 on SSDs. I'll probably upgrade the RAID 10 to SSDs once the 1Tb drives come down a little in price. I have 32Gb of ram on the server.

Also, just my opinion, Sandeep is the man! As my practice has grown and my time for fiddling around with computer stuff has dwindled; he certainly has filled the gap and he understands AC which is more than your local IT guy more than likely.

Sounds awesome. Although I would hate having to redo that RAID 10 when your new SSDs come in. What brand are they: Samsung's EVOs?

Sandeep is them most knowledgeable computing and network guy I have ever known. Kudos on your PoE and your VoIP decision. I guess you could run a separate cable feed to the VoIP, split it with a switch and another router, then provider Wi-Fi for your office. My patients love it. I wish there weren't 4G around or they would love it more.

Did Sandeep build your server or did you go with Dell?

The RAID won't be too bad. I'm going to wait for the Samsung EVO 1 Tb to come down a little so then all I'll have to do is take out one drive at a time and let it rebuild after each drive. Maybe do one a day for 4 days or something, then just turn off the autodefrag and I should be good

Sandeep didn't build it but I took a lot of recommendations from him and built it myself.

My router has a guest WiFi option on it, but the big hospital office in the same building has one up so I just let the patient's use theirs so I can use the speed myself. I have a wifi channel open with a MAC filter on it that my ipod uses to connect to pandora for our in room music and we have an android tablet that we use as a "social media kiosk" so patients can give us reviews online if they wish.