AmericanEHR Webinar - Selecting the Right Hardware for your EHR-based Practice


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Choosing between desktops, laptops or tablets are just some of the choices you face when selecting hardware for your EHR-based practice. There are many questions one needs to answer including the type of EHR software you have selected, the office network and the physical space available.

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  • F because that is the first word you think of if you do not do a-e well
  • Can you use a smart terminal or virtualization.
  • 9 miles an hour
  • Get links to meaningful use
  • AmericanEHR Webinar - Selecting the Right Hardware for your EHR-based Practice

    1. 1. Selecting the Right Hardware for an EHR-based Practice <ul><li>September 20, 2011 </li></ul>Funding to support this Webinar has been provided by Hewlett-Packard
    2. 2. Housekeeping Items <ul><li>Attendees note that microphones have been muted; </li></ul><ul><li>Please use the comment box on the right lower side of your screen to submit questions or comments; </li></ul><ul><li>20-25 minutes has been dedicated for questions and answers at the end of the presentations. </li></ul>
    3. 3. Panelists <ul><li>Dr Eric Goldberg is a practicing internist and CMIO Murray Hill Medical Group and Clinical Assistant Professor of Medicine at New York University School of Medicine. </li></ul><ul><li>Dr John R. Maese is a practicing internist in a small medical practice located in Staten Island NY and is the President of Physician Quality Services. </li></ul><ul><li>Chris Mertens is the Vice President of Personal Systems Group at Hewlett-Packard. </li></ul>
    4. 4. Dr. Eric Goldberg <ul><li>About my Practice </li></ul><ul><li>45 physician multispeciality group </li></ul><ul><ul><li>1 main location </li></ul></ul><ul><ul><li>1 satellite for office based procedures </li></ul></ul>
    5. 5. Went live with EHR in 1998 <ul><li>FAT network setup </li></ul><ul><li>Initially fully wired setup </li></ul><ul><ul><li>Later added Wi-fi as technology developed </li></ul></ul><ul><li>Remote access via Citrix/RDP </li></ul>
    6. 6. Initial hardware <ul><li>Server </li></ul><ul><ul><li>Vendor recommendation </li></ul></ul><ul><ul><li>Compaq </li></ul></ul><ul><li>Workstations </li></ul><ul><ul><li>Generic builds </li></ul></ul><ul><li>Issues </li></ul><ul><ul><li>Server quickly outdated </li></ul></ul><ul><ul><li>Workstation inconsistency </li></ul></ul><ul><ul><li>Network congestion </li></ul></ul><ul><ul><li>Server sprawl </li></ul></ul>
    7. 7. Current hardware
    8. 8. Server <ul><li>Exceeds vendor recommendations </li></ul><ul><li>Redundant server </li></ul><ul><ul><li>Backup </li></ul></ul><ul><ul><li>Reporting </li></ul></ul><ul><ul><li>Rapid changeover in case of hardware failure </li></ul></ul>
    9. 9. Workstations <ul><li>More standardized </li></ul><ul><li>Replacement schedule </li></ul><ul><ul><li>Allows for better budgeting </li></ul></ul><ul><ul><li>Planned maintenance </li></ul></ul>
    10. 10. Printers <ul><li>Workflow driven </li></ul><ul><li>Local printers </li></ul><ul><ul><li>Dual trays </li></ul></ul><ul><ul><li>Model function driven by work requirements </li></ul></ul><ul><ul><ul><li>Secure paper </li></ul></ul></ul>
    11. 11. Network <ul><li>Blend of wired and wireless </li></ul><ul><li>Monitor for congestion/resource utilization </li></ul>
    12. 12. Lessons learned <ul><li>Vendor recommendations are a start </li></ul><ul><li>Need to plan for replacement/upgrades </li></ul><ul><li>Look to integrate changes in network management </li></ul><ul><ul><li>Server consolidation </li></ul></ul><ul><ul><li>Virtualization </li></ul></ul>
    13. 13. The Small Practice Point of View! Dr John R. Maese
    14. 14. Outline <ul><li>Preparation. </li></ul><ul><li>Backup. </li></ul><ul><li>Costs. </li></ul><ul><li>Demystify Terminology. </li></ul><ul><li>Examples. </li></ul>
    15. 15. Preparation <ul><li>You cannot over estimate this! </li></ul><ul><li>Before you even select an EHR you need to survey your office . </li></ul><ul><li>Do you have enough electricity and electrical outlets to operate all these new computers? </li></ul><ul><li>What is your high speed internet connection like? Do you have one? </li></ul>
    16. 16. Preparation <ul><li>Can you get a telephone, Internet, TV package? </li></ul><ul><li>Where is the computer going to go in the exam room or will you go wireless? </li></ul><ul><li>How much space do you have to put the computer? </li></ul><ul><li>Placement of the computer determines where the computer lines need to be dropped? </li></ul>
    17. 17. Ask lots of Questions <ul><li>Who is going to maintain my hardware? </li></ul><ul><li>Ask other physicians who have used the vendor how satisfied they are with support. </li></ul><ul><li>How fast do they respond if the hardware fails? </li></ul>
    18. 18. Ask lots of Questions <ul><li>What are the minimum requirements to operate the EHR? </li></ul><ul><ul><li>How much RAM do I need? </li></ul></ul><ul><ul><li>How much Storage? </li></ul></ul><ul><ul><li>How fast of a CPU or chip do I need? </li></ul></ul><ul><ul><li>What is the minimum screen size? </li></ul></ul><ul><li>Can you access EHR by a tablet PC wirelessly? </li></ul><ul><li>Can you access EHR from home or from a mobile phone? </li></ul><ul><li>How should it be backup? </li></ul><ul><li>What operating system (OS) do you need to run? </li></ul><ul><ul><li>Window s 7 64 bit or 32 bit or XP or MAC OS </li></ul></ul>
    19. 19. Server vs. ASP Model <ul><li>Server </li></ul><ul><li>Software in your office on site. </li></ul><ul><li>Records onsite. </li></ul><ul><li>There are multiple licenses required for servers. </li></ul><ul><li>Remote Access </li></ul><ul><li>Backup, updates, security for the software done by you. </li></ul><ul><li>Application Service Provider </li></ul><ul><li>Software is at some remote location. </li></ul><ul><li>Records are off site. </li></ul><ul><li>Centralized </li></ul><ul><li>Remote Access </li></ul><ul><li>Backup, updates and security for the software done by vender. </li></ul><ul><li>ASP and Cloud Computing are the same. </li></ul>
    20. 20. Backup <ul><li>If you have your own server you need to have onsite and offsite backup. </li></ul><ul><li>Do they have Disaster Recovery and where is the back up? i.e. another state. </li></ul><ul><li>Do not forget the Backup BATTERY supply so your computer and server will not shut down prematurely. </li></ul>
    21. 21. Costs <ul><li>Look at everything in total which includes but is not limited to: </li></ul><ul><ul><ul><ul><li>Cost of initial purchase. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cost of maintenance. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cost of high speed internet access. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cost of office electrical upgrade. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cost of hardware includes server, printers, laptops, tablets etc. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cost of the IT person. </li></ul></ul></ul></ul><ul><li>Cost of other software licenses </li></ul><ul><ul><li>i.e. Microsoft office, antiviral software. </li></ul></ul><ul><ul><ul><li>Multiple software licenses </li></ul></ul></ul>
    22. 22. Contracting <ul><li>Contracts must be reviewed by your attorney who is knowledgeable about technology and healthcare. </li></ul><ul><li>If you outsource the hardware purchase and maintenance make sure the contract addresses product failure, timeliness of repair, bankruptcy, change in ownership of the vendor and if you break up with the vendor. </li></ul>
    23. 23. Do your research! <ul><li>ACP: The Center for Practice Improvement and Innovation </li></ul><ul><li>American EHR Partners </li></ul> and
    24. 24. Terminology <ul><li>Storage = The size of the hard drive = closet. </li></ul><ul><li>RAM (Random Access Memory) = Memory = shelf space. </li></ul><ul><ul><li>Usually purchased in pairs 2, 4 etc.. </li></ul></ul><ul><li>CPU or the Chip is the processor = brain. </li></ul><ul><ul><li>Usually Intel or AMD are the brands. </li></ul></ul><ul><ul><li>Has a speed associated with it in GHZ. </li></ul></ul><ul><ul><li>Range from single core to multiple cores. The more cores the easier it is to do more multitasking. </li></ul></ul><ul><li>A Workstation = Desktop. </li></ul>
    25. 25. Hardware <ul><li>Do not get the minimum requirements, obtain the next level up. </li></ul><ul><li>Buy the right components for your system . Not too little to save money and not too much for features you will not use. </li></ul><ul><li>Average life expectance of a computer is 3-5 years . </li></ul><ul><li>You can use smart terminals, desktop, or laptops. This is based on size of the exam room and preference. </li></ul><ul><li>Good Printers with high duty cycles, 2 paper trays, laser. </li></ul>
    26. 26. Hardware <ul><li>GET THE LARGEST SCREEN SIZE MONITOR YOU CAN! </li></ul><ul><li>When deciding what to buy, if the money is the same or close, choose more RAM and storage space over a faster CPU . </li></ul><ul><li>Router is a device that sends data around a computer network. It can be wireless or wired. </li></ul><ul><li>Scanners that meet the needs of daily scanning and scanning medical records. </li></ul>
    27. 27. Server <ul><li>Server –make sure the vendor gives you some input on this. </li></ul><ul><li>A computer that has software on it so that it can provide services (i.e. programs) to other computers. </li></ul><ul><li>A server has more redundancy that your average computer. </li></ul><ul><li>It is going to be accessed by several users/computers at the same time. </li></ul>
    28. 28. Server <ul><li>A client/server model (local server) is where a server has a program that awaits and fulfills requests from your desktop computer or workstation program. </li></ul><ul><li>A web server model (Internet server) is a model where the server is not local but somewhere on the Internet. The desktop/workstation uses a Web browser to request programs from the server. </li></ul>
    29. 29. Server <ul><li>RAID Redundant Array of Independent Disks. </li></ul><ul><li>RAID-0: It offers the best performance but no fault-tolerance. </li></ul><ul><li>RAID-1: This type is also known as disk mirroring and consists of at least two drives that duplicate the storage of data. </li></ul>
    30. 30. Scanners
    31. 31. Server, Router, Battery, Etc.
    32. 32. Computer Placement
    33. 34. Computer Purchased <ul><li>Mini Tower </li></ul><ul><li>Genuine Windows® 7 Professional, w XP Mode, Media, 32-bit, </li></ul><ul><li>CPU Intel® Core 2 Duo E7500 (2.93GHz, 3M, 1066MHz FSB) </li></ul><ul><li>RAM = Memory 4GB DDR3 Non-ECC SDRAM,1333MHz, (2 DIMM) </li></ul><ul><li>Monitors 18.5 to 24 inches </li></ul><ul><li>Hard Drive 320GB 7,200 RPM 3.5&quot; SATA, 3.0Gb/s Hard Drive with NCQ and 16MB Cache </li></ul>
    34. 35. Server <ul><li>RAM = Memory 8 GB </li></ul><ul><li>CPU 2.4 GHz Quad core </li></ul><ul><li>RAID 1 </li></ul><ul><li>Two 500 GB Hard Drives </li></ul><ul><li>Operating System Windows Server 2008 </li></ul><ul><li>10 CALS = Client Access Licenses </li></ul>
    35. 36. Other Components <ul><li>You might need a wireless card. </li></ul><ul><li>Router / Firewall needs to be encrypted. </li></ul><ul><ul><li>HIPAA compliant i.e. Encrypted 256 bit. </li></ul></ul><ul><li>FAX server. </li></ul><ul><li>In most cases you do not need a video card or speakers for your work stations/ desktop computers. </li></ul>
    36. 37. HELP <ul><li>Regional Extension Center (RECs) </li></ul><ul><ul><li>RECs are authorized by The HITECH Act . </li></ul></ul><ul><li>The RECs will support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs). </li></ul><ul><li>RECs are designed to help primary care clinicians use EHRs.   </li></ul>
    37. 38. Conclusion <ul><li>Preparation is key. </li></ul><ul><li>Collaborate with other physicians in your geographic and specialty area . </li></ul><ul><li>Use an ASP model for hosting your software. </li></ul><ul><li>Use American EHR Partners and ACP resources to start. </li></ul><ul><li>Reach out to your local REC. </li></ul><ul><li>Are there any questions? </li></ul>
    38. 39. Links <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
    39. 49. Questions & Discussion
    40. 50. Selecting the Right Hardware for an EHR-based Practice <ul><li>September 20, 2011 </li></ul>Funding to support this Webinar has been provided by Hewlett-Packard