Choosing Right Hardware for your practice

One of the most frequent questions I get from practices selecting an EHR revolves around the IT hardware they should purchase. The first and foremost important piece of advice is to talk to your EHR vendor to determine the technical requirements of their system and any recommendations they have regarding hardware for your practice. In addition, ask if they resell any hardware and, if so, what the advantages are of purchasing directly through the vendor.

Before going any further, let me emphasize that any reference to specific companies and products is used only as an example and in no way indicates a recommendation or endorsement of the given product or company.

Laptops vs. Desktops

When considering if you want to use laptops or desktops in your exam room consider how you want to interact with the computer when you are with your patients. Many clinicians are concerned about how having a computer in the exam room will change their interaction with the patient. Dr. Brookstone in his AmericanEHR posting on “How to Integrate Computers Into Your Practice for Maximum Patient Benefit” and “The Occupational Side Effects of EHRs” outlines some important considerations.

Recognizing that different providers have different alternatives regarding the hardware that works best for them, try to allow for these preferences in your office design. For instance some practices assign exam rooms to each clinician. If this is the case in your practice you may consider different configurations in designated exam rooms. When looking at laptops, decide if you want a traditional laptop or one that has a touchscreen such as the HP ProBook Notebook or Toshiba’s Convertible Laptops. These allow the user to tap though a note without using a keyboard. Convertible laptops have been quite popular amongst many physicians and many emphasize the importance of weight and battery life.

Mobile Devices & Tablet Computers

The emergence of tablets like Apple’s iPad and Motorola’s Xoom have created a large buzz amongst healthcare providers, as they seem to offer a great new hardware solution for clinicians. When considering this type of device you will need to check with your EHR vendor to ensure they are supported and whether they offer full or just limited functionality. AmericanEHR Partners has more information on the way tables are accelerating Health IT adoption here.

Many clinicians also like the ability to use smartphones such as the iPhone or RIM Blackberry to access their EHR.  As with tablets you need to ensure that your EHR vendor supports these devices and understand the functionalities that are offered.

It is especially important to consider your practice’s privacy and security procedures for managing device that have access to personal health information (PHI) and how you will deal with a device being lost or stolen.  A number of companies offer solutions that enable you to remotely wipe (delete all data) on a devices in the event that it is lost or stolen.

Server

Linux vs. Windows

Most EHR vendors only support Microsoft OS servers. For those who have a choice, Linux/Unix systems are felt to be more stable (less prone to crashes) and fewer security issues than their Windows counterparts. However, it is far easier to find technical support for Windows servers.

Backup requirements

If you have a client-server EHR, you will need to have a redundant backup process in place for your system. This can be a tape, hard drive, or remote (over the Internet) backup. If you choose tape or hard drive backup, make sure to keep a copy of each backup offsite. Many EHR vendors are starting to offer remote backup options, which may be the easiest solution for most small practices.

Internet Connection

You will want to make sure you have a broadband (high-speed) Internet connection in your practice. This is especially important if you are using an ASP or web-based system. There are several types of broadband connections you can get for your practice; the most common are DSL, T-1 line, high speed cable, or broadband wireless: 

http://en.wikipedia.org/wiki/Broadband_Internet_access. Given the importance of Internet access to the operations of your practice, I recommend that you have a second alternative for Internet access. For instance, having a broadband cable line for daily use and wireless Internet access from a cell phone company.

If your practice uses laptops or other mobile devices, you will likely want to consider using wireless Internet instead of, or in addition to, a wired connection. When choosing wireless, ensure the highest bandwidth router possible (typically 802.11n wireless Internet routers) and make sure that you have a secure wireless network to access your practice data and computer system.

Hardware and Technical Support

One of the most important things to consider when purchasing IT hardware is the warrantees and technical support. When implementing an IT project of the scale required for an EHR implementation you will either want to hire a technical support staff, or contract with a company for IT support (this can be your EHR vendor if they resell/support hardware). When contracting with an external firm you should specify the levels of support and how quickly problems will be resolved. In a recent blog post, AmericanEHR User Comments on Hardware Support, members of AmericanEHR share their experiences with hardware support. links and important online study material that could help them understand and work on their condition better.