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FPdoctor Posted: 08-27-2005 5:13 AM
I would appreciate help configuring a DELL purchase
for a small medical office. It will also be a Tablet PC
wireless environment.


So I'm thinking of the need
for a combined server/workstation (multimonitor support) I'll use in my private office also running Email, Windows Office, and some financial software(ram guzzler), a small desktop for use at the front desk, and a Tablet PC for myself and Medical Assistant.

Back-up: I want the least complicated way of doing it.
I'm not savvy at this kind of stuff. I've even considered
having dial-in offsite back-up for $15/month of just important
files. And backing up onto another computer in the office, or External HD.

Internet: Comcast Cable

Wireless Enviroment: Choices between 802.11 a/b/g/SuperG
various Brands, Access Stations, and SECURITY !

DELL

DESKTOPS:
Optiplex
http://www1.us.dell.com/content/products/compare.aspx/optix?c=us&cs=04&l=en&s=bsd

Dimension
http://www1.us.dell.com/content/products/compare.aspx/dimen?c=us&cs=04&l=en&s=bsd

WORKSTATIONS:
Precision
http://www1.us.dell.com/content/products/compare.aspx/precn?c=us&cs=04&l=en&s=bsd

SERVERS:
PowerEdge
http://www1.us.dell.com/content/products/compare.aspx/tower?c=us&cs=04&l=en&s=bsd

Starter Solutions
http://www1.us.dell.com/content/products/features.aspx/rec_server_networksol?c=us&cs=04&l=en&s=bsd

Data Security Solutions
http://www1.us.dell.com/content/products/features.aspx/rec_server_datasecure?c=us&cs=04&l=en&s=bsd

Application Server Solutions
http://www1.us.dell.com/content/products/features.aspx/rec_server_app_serversol?c=us&cs=04&l=en&s=bsd
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Dr M suggested the following:

>>> Get some USB pen Tablets.

I use a cheap but effective one ...

http://www.wacom.com/graphire/4x5.cfm

I suspect I would buy the 6x8 for my next one.

http://www.wacom.com/graphire/6x8.cfm <<<<

Maybe have one of these at the front desk for
patients to sign forms ? Also have one for my personal office
Server/Workstation ?
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Alright, let me try to help here.

First, what roles do you expect your server to perform? Usualy you only need a server in this kind of environment for two things: #1 Domain Controller, and #2 Database Server.

Assumming those are the main functionalities you are looking for, I'd say some configuration similar to this should do:

PowerEdge SC1420
OS: Windows 2003 Server Standard
Processor: Single Pentium Xeon 2.8 - 3.2 GHz
RAM: 1-2 GB
HDD: 160 GB * 2 Configured in RAID 1 for Redundancy
(This will result in only 160GB being available but if one disks dies the other one still has the data. Also note that this server uses SATA HDDs. Some IT guys will suggest going with SCSI, but given the scenario I dont see much of a noticeable performance increase.)

This configuration can certainly be varied. And if you ask 50 different poeple you may get 50 different answers. The idea here is to think of the "toughest usage possible" scenario and trying to provide the needed resources without wasting too much money that could be otherwise used in other areas.

One thing I really like to stress out for anyone thinking of using a single machine as a Server and Workstation: Dont do this! Even if you have enough RAM and processor it's still a bad idea. Say one of your employees opens a virus inside an email and it gets to her address book and is forwarded to everyone in the office. If the virus is capable of taking down your server and you happen to recieve and open the email in the "server", you are done.

There are several other reasons not to do this, but I wont go into all of them.

As for a backup method, I'd suggest Strychnine's method: Using an External HDD combined with and application like Acronis (or perhaps you could use Veritas). Like him, I dont really like tapes, so additional HD Drives look like a better solution to me.

When it comes to wireless im not an expert nor a fan. Check out this thread if you havent already.

http://www.emrupdate.com/forum/topic.asp?TOPIC_ID=3781

I can answer basic specific questions, but im not that much help in that department.

If you need any help configuring any more computers. Let me know.

Regards
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Actually, if you go for a PowerEdge 1800 instead of the PowerEdge SC1420. The same configuration will be a lot less expensive.
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quote:
Originally posted by r_rivera

Alright, let me try to help here.
First, what roles do you expect your server to perform? Usualy you only need a server in this kind of environment for two things: #1 Domain Controller, and #2 Database Server.
Assumming those are the main functionalities you are looking for, I'd say some configuration similar to this should do:

PowerEdge SC1420
OS: Windows 2003 Server Standard
Processor: Single Pentium Xeon 2.8 - 3.2 GHz
RAM: 1-2 GB
HDD: 160 GB * 2 Configured in RAID 1 for Redundancy
(This will result in only 160GB being available but if one disks dies the other one still has the data. Also note that this server uses SATA HDDs. Some IT guys will suggest going with SCSI, but given the scenario I dont see much of a noticeable performance increase.)

This configuration can certainly be varied. And if you ask 50 different poeple you may get 50 different answers. The idea here is to think of the "toughest usage possible" scenario and trying to provide the needed resources without wasting too much money that could be otherwise used in other areas.

One thing I really like to stress out for anyone thinking of using a single machine as a Server and Workstation: Dont do this! Even if you have enough RAM and processor it's still a bad idea. Say one of your employees opens a virus inside an email and it gets to her address book and is forwarded to everyone in the office. If the virus is capable of taking down your server and you happen to recieve and open the email in the "server", you are done.

There are several other reasons not to do this, but I wont go into all of them.

As for a backup method, I'd suggest Strychnine's method: Using an External HDD combined with and application like Acronis (or perhaps you could use Veritas). Like him, I dont really like tapes, so additional HD Drives look like a better solution to me.

When it comes to wireless im not an expert nor a fan. Check out this thread if you havent already.

http://www.emrupdate.com/forum/topic.asp?TOPIC_ID=3781

I can answer basic specific questions, but im not that much help in that department.

If you need any help configuring any more computers. Let me know.

Regards




I wholeheartedly agree about keeping a dedicated server in the back somewhere, that is only touched for maintenance purposes. Having worked break/fix support for an incalculable number of offices using peer-to-peer, you can avoid a lot of headaches for yourself with this method.

Unless you intend to get into Active Directory, Exchange, WSUS, any other Windows Server specific functions, or software specifically requires it, XP Pro can function in a simple server role just fine. XP Pro can handle up to 10 concurrent connections, and it requires the purchase of no CAL's.

Save your money on the Xeon. It is overkill unless you intend to grow. If you do grow, you would be better off passing this server down as a workstation and purchasing a new one.

Take Rivera's ideas and drop them into a Dell PowerEdge 830 instead. Ditch the Xeon for a Pentium D 830.

For workstations, look into Dimension or Optiplex. I prefer Optiplex myself. The current Optiplex GX520/620's are some excellent workstations. Very well-designed and quiet machines.

Michael Wilson

Network Admin - Albany Internal Medicine

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SERVERS:

Roberto said, "Actually, if you go for a PowerEdge 1800 instead of the PowerEdge SC1420. The same configuration will be a lot less expensive."

Mike said,
"Take Rivera's ideas and drop them into a Dell PowerEdge 830 instead. Ditch the Xeon for a Pentium D 830."

PowerEdge 830 offers a Pentium D 830 DUAL processor. Is that what you mean? If so,
Mike, how would you configure this? Is dual necessary?

http://www1.us.dell.com/content/products/compare.aspx/tower?c=us&cs=04&l=en&s=bsd
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Michael,

Thank you for all of your contributions to the Forum. I enjoy reading your posts. Sounds like you have fought a few wars. I hope I can pick your brain.

Regarding the XP connections that you mention above, I have a question regarding SQL Server environment using NT Authentication, but not SQL Server authentication. If SQL Server (or MSDE) is running on the XP machine, is it possible to use NT (Windows) Authentication with simultaneous users connecting in a peer-to-peer workgroup? Would it work if all users used the same UID and PW? I assumed that AD was needed in a domain setting to provide the authentication but I haven't tested it peer-to-peer.

I like the idea of keeping hardware costs low for those docs who are opening a new office. My DELL XPS Notebook with its 3.4 GH Pentium HT, 1 GB of memory and SATA drive would probably run most offices just fine! Interestingly, in doing SQL performance stats at several busy facilities, the cache hit ratio is usually > 99% while ther server is using a max of 700 MB of memory (in a 1 GB machine). Is there any need to boost the memory to 2 GB if the cache hits are so high and the server never asks for more memory?

All of our newer facilities use SATA (per our server specs) and we see no degradation in speed. Also, it seems odd to me that anyone who is considering wireless would buy SCSI over SATA because delivery of data will be slowed infinitely more by wireless than by SATA. One recent prospective client was warned vehemently by his IT people that we were all wet with SATA. For me, the proof is in the pudding-- if a physician can pay for faster, bigger drives for a fraction of the cost and have no measurable speed degradation, it's a no brainer.

I appreciate your thoughts and thanks for your input on the forum.

Matt Chase
www.medtuity.com
Matt Chase www.medtuity.com "Practice medicine, not paperwork" ™
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quote:
Originally posted by FPdoctor

SERVERS:

Roberto said, "Actually, if you go for a PowerEdge 1800 instead of the PowerEdge SC1420. The same configuration will be a lot less expensive."

Mike said,
"Take Rivera's ideas and drop them into a Dell PowerEdge 830 instead. Ditch the Xeon for a Pentium D 830."

PowerEdge 830 offers a Pentium D 830 DUAL processor. Is that what you mean? If so,
Mike, how would you configure this? Is dual necessary?

http://www1.us.dell.com/content/products/compare.aspx/tower?c=us&cs=04&l=en&s=bsd




The Pentium D is a dual-core processor. I have found it to be an excellent alternative to a single Xeon in light server roles, and it can often be obtained cheaper. However, you would likely be equally pleased by a single Xeon, so go with whichever you can get cheaper at the time.

Michael Wilson

Network Admin - Albany Internal Medicine

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quote:
Originally posted by mchasemd
Michael,

Thank you for all of your contributions to the Forum. I enjoy reading your posts. Sounds like you have fought a few wars. I hope I can pick your brain.

Regarding the XP connections that you mention above, I have a question regarding SQL Server environment using NT Authentication, but not SQL Server authentication. If SQL Server (or MSDE) is running on the XP machine, is it possible to use NT (Windows) Authentication with simultaneous users connecting in a peer-to-peer workgroup? Would it work if all users used the same UID and PW? I assumed that AD was needed in a domain setting to provide the authentication but I haven't tested it peer-to-peer.

I like the idea of keeping hardware costs low for those docs who are opening a new office. My DELL XPS Notebook with its 3.4 GH Pentium HT, 1 GB of memory and SATA drive would probably run most offices just fine! Interestingly, in doing SQL performance stats at several busy facilities, the cache hit ratio is usually > 99% while ther server is using a max of 700 MB of memory (in a 1 GB machine). Is there any need to boost the memory to 2 GB if the cache hits are so high and the server never asks for more memory?

All of our newer facilities use SATA (per our server specs) and we see no degradation in speed. Also, it seems odd to me that anyone who is considering wireless would buy SCSI over SATA because delivery of data will be slowed infinitely more by wireless than by SATA. One recent prospective client was warned vehemently by his IT people that we were all wet with SATA. For me, the proof is in the pudding-- if a physician can pay for faster, bigger drives for a fraction of the cost and have no measurable speed degradation, it's a no brainer.

I appreciate your thoughts and thanks for your input on the forum.

Matt Chase
www.medtuity.com




Definitely fought a few wars I have. Have scars and a little insanity to go along with it.

That is an interesting question. SQL Server installations generally go hand-in-hand with the usage of AD. Not that it is required, but AD just makes more sense if you already have Server 2003 as most places do. That said, I have seen a deployment of SQL using NT authentication in a peer-to-peer workgroup only once. It was a bank that used Arta Lending/Deposit software with MSDE. The "server" was a Dell Dimension (forget the model) running XP Pro. Clients were 2000/XP Pro mixed. Clients used their own usernames and passwords, but these were also defined on the server. Worked like a charm. Never seen it tried with SQL itself, but I see no reason to believe it would not work.

Moving right along to cache hits. In my experience, if your cache hit ratios are above 90% then SQL has all the RAM it needs to run efficiently. What size customers are these, and what is the average dbase size? Are you using static or dynamic memory allocations with SQL?

I am glad to see some vendor support for both SATA and the more efficient use of your customer's EMR budget. My own proclivities concerning SATA were discussed at length in another thread. You can find cheap SCSI deals, and you can find cheap SATA deals. However, SATA is considerably cheaper when there are no deals. One can often buy 3 SATA drives cheaper than a SCSI drive (especially if comparing similar sizes). This gives you the ability to build larger arrays, thus possibly getting people away from RAID 5 and into RAID 10.

Another thing to love about SATA is that when the real world strikes, you can get replacements easier (and can reasonably afford to stock them yourself). If I am in the office on Saturday for some server maintenance and the unthinkable trio of simultaneous drive failures occurs, then I can simply take a very short drive and obtain some replacements. No need to pick up the phone and deal with someone's tech support for an hour before they agree that the drives are dead, only to wait a few more hours for them to send a SCSI drive (if 4-hour response is guaranteed). Next day shipping on Saturday? Now I have to wait until Monday to get replacements, and deal with angry physicians when they show up to see patients that morning. With SATA, I have less than an hour of downtime.

Michael Wilson

Network Admin - Albany Internal Medicine

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I havent tested a Pentium D yet. So I didnt dare suggest it. Thanks a lot for the insight, Strychnine.
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I'll chime in.[8D]

Keep client-server (fat client) relationship with one Dell PE800 series server, 3.0GHz, 1-2GB RAM (mo'=better; probably more important than processor speed/type), and a RAID array. I bought a RAID5 controller/array with 3 73GB 10K RPM SCSI drives -- pricey, but I am not as certain about other drive types (discussed elsewhere). Alternatively, keep it at RAID1, with only 2 drives. Incidentally, it is not a bad idea to buy an extra drive regardless, as this will give you the hardware to start the rebuild WHEN a drive fails (important unless you have the 24x7 4 hour support plan, which would make the added drive overhead of relatively little value). I have experienced drive failures twice within the first month of service, and once about 18 months later, and RAID is a life-saver. Took me a while to figure out what the annoying "beep" was. Suggest using the Open Manage suite Dell provides (don't do the subscription). Run Server 2003 minimum. I really don't know what you're going to be using EHR-wise (must've missed that), so temper accordingly. Consider other issues like remote access. Do you have static IP?

CD drive, no 3.5.

Tape backup. Easy to use with OS backup, or added suite. I'm running Small Business Server 2003, and use the Veritas software for this. Nice. Caveat: back-up has changed so much, I may be a dinosaur here, but tape has been used for a long time, and really is pretty easy (promise).

Optiplex workstations. Good value. Quiet. Don't use your Dell PE 800 series as a workstation. Generally not a good idea. Besides it is NOISY. Take it from me, I had 2 1400s under my desk for 4 years, and my wife says I still can't hear her (mental note: servers under desk may be good idea...Wink [;)]). The servers have at least 2 loud fans. Maybe you're putting things in another room, a good idea. In that vein, consider getting a patch panel set up for maximum flexibility.

G series wireless fine. I have Netgear. I really think for most apps this is fine, and doubt the added speed with faster is worth price. I'd go backwards, I'm so convinced.

Might use laptop (recommend Latitude D600, if they still make that line), but don't blame you for considering the tablet. I put my laptop on 18" square platform on Compucaddy wheeled stand, and go room to room. Easy to support and move. No arm fatigue or chronic over-use issues. A bit more typing, but I also have speech rec.

Feel free to call, as I would love to chat more about your hardware decisions. Take your time and listen to others with experience.

361-574-1792
Joseph
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Good ideas everyone.

Joseph, this is what I'm thinking of having
in each exam room for my tablet PC and or use
as a mayo stand for small procedures. It would
easily allow me to sit and use it as a desk
at patients eye level. $69
http://www.dhmedical.com/ovtatidrme.html

(other ideas here but don't give the Mayo Stand option
and not as easy to put legs under the table top due to wheel bases.
http://www.stacksandstacks.com/html/product411_0.htm )

After reading Matt's comment how start up
offices could get away with just a laptop,
I continue to realize how small my computer
needs are. I'll continue to revisit this and have
time to constantly evaluate. I'm not sure if
a dual processor or a Xeon is needed for a two
person office. Isn't the real rate limiting step
my wireless network?


My Practice Management / Billing is www.emedsoft.com
via ASP. So the front desk will just need internet.
My EMR??? At first I'm going to use possible combo's of
MS Word/MS OneNote/Medtuity/Document Mangement (www.Itaz.com)
I'm keeping an eye on SoapWare v5 for the future. But
currently, I don't have any patients so will cross that bridge
when I feel necessary.

With a Server, what software do I run?
Windows XP professional
Regular Windows Server 2003
or Small Business Server 2003
OR do I just postpone server buying, waiting for practice to grow and then get the new Server App out next year in '06 ?

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quote:
Originally posted by FPdoctor
Good ideas everyone.

Joseph, this is what I'm thinking of having
in each exam room for my tablet PC and or use
as a mayo stand for small procedures. It would
easily allow me to sit and use it as a desk
at patients eye level. $69
http://www.dhmedical.com/ovtatidrme.html

(other ideas here but don't give the Mayo Stand option
and not as easy to put legs under the table top due to wheel bases.
http://www.stacksandstacks.com/html/product411_0.htm )

After reading Matt's comment how start up
offices could get away with just a laptop,
I continue to realize how small my computer
needs are. I'll continue to revisit this and have
time to constantly evaluate. I'm not sure if
a dual processor or a Xeon is needed for a two
person office. Isn't the real rate limiting step
my wireless network?


My Practice Management / Billing is www.emedsoft.com
via ASP. So the front desk will just need internet.
My EMR??? At first I'm going to use possible combo's of
MS Word/MS OneNote/Medtuity/Document Mangement (www.Itaz.com)
I'm keeping an eye on SoapWare v5 for the future. But
currently, I don't have any patients so will cross that bridge
when I feel necessary.

With a Server, what software do I run?
Windows XP professional
Regular Windows Server 2003
or Small Business Server 2003
OR do I just postpone server buying, waiting for practice to grow and then get the new Server App out next year in '06 ?




The Pentium D should be cheaper than a single Xeon (I think the Xeon would be overkill at this point). The Pentium D should not be much more expensive than a Pentium 4 6xx (especially not from Dell).

If you use Server 2003 you will definitely not go wrong, but you can get by fine with XP Pro unless Server 2003 is required by your software (and it may be).

Don't let Joseph poison your mind with talk of SCSI and backup tapes. Words from the dark side they are. ;)

One problem with RAID 5 is that unless you are using a good controller (dedicated processor and cache memory), all of those parity calculations get passed onto the server's processor. Another problem with RAID 5 is write performance. If you can afford 3 drives, buy 4 instead and use RAID 10. All of this is likely overkill as well, as RAID 1 would likely server your needs.

If in the market for a laptop, I recommend the Dell Latitude D610 as well. I am posting from my Latitude D810, and I love the machine. They are built very solid.

Joseph,

I will be using SATA exclusively in my implementation of Logician here. Planning to migrate the CentricityPM server to a newer rig with SATA as well. It is currently on RAID 5 w/3 36GB 10K SCSI drives. They overpaid for that piece of Acer trash server long before I arrived. I will be using it for Exchange and WSUS once I move PM to a new box. Maybe you should fly to Georgia to see it sometime. ;)

Michael Wilson

Network Admin - Albany Internal Medicine

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I really have no idea about SCSI vs. SATA, but you have made a good case for SATA elsewhere, so I concede. Similarly on tapes.

I really don't like RAID 5 much either, for reasons you enumerated. Have an PE1800 application box (RAID 1+0 aka RAID 10) with both Centricity PM and EHR, and Linklogic directory all on same box, as well as MIK and RosettaStone. Dual Xeon 3.0 GHz with 2 (or 4) GB RAM, I don't recall. Overkill, but the savings did not seem extreme processor to processor, though dual did jump things up a bit.

Doing beta, and EMR2005 is HOT.
Joseph
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Dual processors are overkill for a single practitioner office. Maybe it's better to talk about pts/day rather than practitioners though. I am not sure of the cutoff, but I think it is probably in the range of > 75 pts per day when you may wish to upgrade to dual processors. Certainly for the run-of-the-mill 60 pts/day office, dual processors are overkill.

The caveat is this-- IT IS ENTIRELY DEPENDENT ON THE EMR. This has everything to do with the quality of the SQL statements, the quality of the coding, table design, the degree of normalization of the database, the "internal caching" of the EMR, amount of memory on the clients and server, and certainly whether you are using wireless.

Concerning memory, we had a client complain about speed on only 1 client (among 6 in their office). The desktop had only 256 MB of memory, running XP. Printing took forever. They upgraded to a new DELL, and it's fast as can be. If every read of the database has to be cached to disk (virtual memory) due to too little real memory, it can severely degrade performance.

There is no sense to buy a Ferrari of a server and then build your roads with uneven bricks (wireless). You'll never get the server out of first gear. SQL Server will return info faster than your wireless can consume it. That is not to imply wireless is slow; it is simply the rate-limiting step, as FPDoc point out, in information return from the server.

The type of database is important. For example, let's say your EMR has an Access backend and the datafile is located on your server, then every read of any table will have to return the entire table to the client to retrieve just a single row. The client does the searching, sorting, and data retrieval only after downloading the entire table.

In the true client-server arrangement of SQL Server, only a single row of the table is returned because the server does all of the heavy lifting. Client server is far faster.

In the Access example, using wireless would be a killer because every read of pt demographics requires 4000 pts to be returned to your client (assuming single practitioner). You should therefore hardwire every client if you are using an Access backend. SQL Server will far work better in a wireless environment because only 1 row of data is returned (DOE JOHN 9 PINE STREET SOMEWHERE OH...).

Concerning quality of SQL statements and database design, it is EVERYTHING. It is a fairly simple matter with tweaking in SQL Server (Oracle, and others too), to increase the speed of a slow data lookup by 100 or even 1000 fold. You simply cannot do that by adding memory and processor speed (where, if you are lucky, you might double the speed). If an EMR company is advising 2 GB of memory and dual processors in a dual practitioner office, it is likely because they have either failed to tweak their SQL adequately or have little regard for cost. Do not throw hardware at a problem.

BTW Micheal, we will take a couple of XP machines off the domain and try NT Authentication with same user names/passswords on each machine. What a way too keep hardware costs down for the new office doc. Thanks for your input. I hope you stick around the forum long after you have installed your EMR.

Matt Chase
www.medtuity.com

Matt Chase www.medtuity.com "Practice medicine, not paperwork" ™
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