At first, it seemed like a throw-back to an older era of computing, to the age of mainframes and dumb terminals, but no matter. PC-based terminals from NComputing Inc. were exactly what the doctor ordered, when lead physician Alberto Sobrado of Community Medical Professionals (CoMedPro) in North Andover, Mass. went looking for a computing solution to support the clinic’s new integrated practice management system.
As a medical practice, CoMedPro had some unique requirements, but other small businesses can also benefit from the NComputing technology, Sobrado believes.
NComputing sells hardware/software kits that allow companies to connect relatively inexpensive book-size terminal devices to a Windows PC or server – up to six per PC, 30 per server – either over a network or through a PCI card in the computer. Once the terminals are equipped with monitors, keyboards and mice, employees can work at them exactly as they would a PC.
It makes sense to share PCs because dedicated computers are almost always under utilized. NComputing says most employees use from one to five percent of the processing capacity of their computers. Using terminals can generate a tenfold reduction in computing costs, the company’s claims. It also minimizes environmental impact because the terminals draw less power than PCs – in fact, they get all their power from the host computer. And it helps de-clutter working spaces, something that was particularly appealing to CoMedPro.
Sobrado is one of two doctors in a general practice that also employs four nurse practitioners and another 15 support staff. CoMedPro manages an estimated 10,000 patients in a clinic with 12 examining rooms in two separate practice areas.
Moving to the Next Level
Like many clinics, CoMedPro recently took a major step forward in computing by implementing an integrated software solution from eClinicalWorks. Medical practices first started using computers to run insurance company claims systems about 20 years ago. Then online pharmacy ordering systems began to appear and finally, in the last ten years, some practices started using electronic medical records (EMR) systems that allow doctors to make examination notes electronically and store patient information online.
Until the last few years, however, these functions were all separate. It is only with the introduction of solutions such as eClinicalWorks that health care clinics were able to buy all-in-one solutions that integrate billing and accounting, EMR, appointment scheduling and other front office practice management functions. “But once you jump into that league,” Sobrado said, “you’re looking at [installing] real servers and real networks. It gets very expensive.”
CoMedPro chose eClinicalWorks, one of the leading vendors in the space, in part because it was able to get some subsidy from one of the insurance companies with which it works. Costs to implement such systems can range from $50,000 to $200,000, Sobrado says. The new system went live at CoMedPro in April of this year.
One issue during planning was how to extend computing into the examining rooms. Most physicians use laptops or pricey tablet PCs that they carry from room to room and either connect to local servers over a wireless LAN or plug into an Ethernet port in each room. Sobrado didn’t like the idea for a few reasons. The practices he visited where physicians used tablets appeared cluttered with wires and batteries. He was also concerned about the risks of damage to portable units if dropped and the constant wear on touch screens used all day.
Not-So-Dumb Terminals
The alternative – desktops in each room – would have been even more expensive and would have added to the clutter of wires, putting them at greater risk of damage in rooms where children sometimes accompany parents and are left unsupervised by clinic staff. Sobrado saw the NComputing products reviewed in computer magazines and bought one unit to try out at home. It worked well enough that he was convinced it was the answer for the clinic.
NComputing has two solutions. One uses an Ethernet network to connect the company’s terminal devices to the primary or host computer. With the other, you install a PCI card inside the host and can connect up to three terminal devices – different from the Ethernet models – per card. Each system has its pluses and minuses.
The Ethernet solution offers a user interface that Sobrado characterizes as similar to a remote access screen such as in Windows Remote Desktop, the utility built into Windows XP and Vista that lets another person log on to your computer over a network. The image is noticeably less crisp than on a screen connected directly to a PC. And response times are “a little sluggish – but not too bad.” The PCI card solution offers a much crisper image and better performance but cable runs from the terminals to the host cannot be longer than 10 meters (about 33 feet).
Sobrado preferred the PCI solution because of the better performance and image. “When it’s something you use all day every day – you get a little picky about it. It’s like your cell phone or your glasses. It has to be just right.” That said, if he had it to do over, he might compromise and go with the Ethernet solution in part to get around the 33-foot limitation. He’d attach all the terminals to one powerful server.
Sobrado pointed out that in a classroom, the original market for the NComputing products, the distance limit is not a big issue, but in his clinic, it was. He said the terminals really only work well at less than 25 feet away from the host. CoMedPro ended up implementing a hybrid solution with a computer in some examining rooms attached to NComputing terminals in three nearby rooms. The clinic also placed computers in the front office with terminals for reception and other staff.
Problem Solved
Sobrado is generally happy with the NComputing solution. “It works well, it’s reliable. From any station, you can do everything you could from a PC,” he said.
With the examining room systems, performance is excellent because he and his partner are use one terminal at a time as they move from room to room. At the front desk, where each of the stations is in use all the time, staff might see “a little bit of difference” in performance compared to using a dedicated PC.
“The key,” Sobrado said, “is to invest in very good computers.” CoMedPro bought ten dual-core Pentium 4 models from a local integrator and loaded them with two gigabytes of memory, double the recommended minimum. The clinic runs three NComputing terminals off each computer. It is possible to put two cards in each computer, but the distance to reach additional stations in the CoMedPro facility would have been too long.
In the front office, each practice area has its own dedicated computer, again, with three NComputing stations attached to each. This was a mistake, Sobrado said, because if one of the computers goes down, the whole area loses access. In future, he’ll cable them differently so that some stations in each area are wired to the computer located in another area to provide redundancy.
He likes the NComputing solution, but given the way he set up the systems, it may not have been much cheaper up front than dedicated desktops.
Cheaper in the Long Run
The NComputing Xtenda X300 kit, which includes a PCI card and three terminal units lists for $250. But then you have to add monitor, keyboard and mouse for each station. Sobrado wanted a finished look for the examining rooms so he invested an additional $550 to mount each setup on a computer arm from ICWUSA.com Inc. They mount on the wall and allow him to pull the keyboard and monitor forward to use them during an examination.
The real pay-back will come, theoretically, when CoMedPro has to change out its computers, which Sobrado estimates the clinic will do every three or four years. Now instead of replacing 30 PCs, it will only have to replace 10 – and all of the terminal stations will benefit from the new (presumably) more powerful host computers.
Cost in any case was only a “minor” consideration for CoMedPro. Sobrado was more concerned about finding a solution that didn’t involve using laptops or tablet PCs, helped declutter the small examining rooms and provided a safe environment in which there were no trailing cables for patients, or children of patients, to trip over or pull out. “Safety,” he says, “was my first concern.”
The NComputing solution delivered on all counts, and will also probably be cheaper in the long term – if not in the short. Sobrado advises other small business to take the time to think through the two options the company offers. He designed the solution for CoMedPro himself, but hired an engineer to help him implement it. He suggests hiring a professional to help in planning and solution design as well.
Based in London, Canada, Gerry Blackwell
has been writing about information technology and telecommunications for a variety of print
and online publications since the 1980s.
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