We understand medical practices today are suffering from lower patient volumes and decreased reimbursements. That's why we designed XLEMR to require a minimal hardware investment. In most cases, you may be able to get started with the hardware you already own. That way you can upgrade your hardware on a timetable that is comfortable for your budget. Of course, your specific hardware needs will depend upon what you currently have and the size of your practice.

XLEMR Architecture                       System Requirements                       Hardware Options                       Do I Need a Server?

XLEMR has two main system architectures, client-server and stand alone. The client-server model is appropriate for most office-based practices, while the stand alone model is perfect mobile providers. The architecture you select will play a large role in hardware selection. You have many hardware options for each model.

The client-server architecture is appropriate for most office based practices that require information sharing between different users and workstations. Smaller offices with a limited number of users and eight or fewer workstations can use a workgroup solution, which may or may not require a server. Workgroups are fast and easy to setup and maintain. Smaller work groups do not require a server; they work well using an enhanced workstation to host the data. Medium sized offices with nine or more computers may want to consider purchasing a server. A server and domain setup works best for larger offices with many users and workstations.

Our stand alone architecture is great for mobile providers that travel to different locations to see patients, such as geriatricians or home care specialists. In this case, XLEMR runs entirely on a single computer, usually a laptop or convertible tablet PC. If you need to share data with other providers, our software will synchronize your data with a main computer located in your office or home. The main computer does not need to be a server-class machine.

XLEMR requires a computer running the Windows operating system, version 2000 or higher and Microsoft Office version 2002 or higher. For best results, XLEMR recommends the following hardware:

• Operating system: Windows XP or Windows 7. Professional versions required for HIPAA compliance.
• Processor speed: 2 GHz, minimum.
• RAM: 2 GB, minimum.
• Hard Drive: 120 GB hard drive, minimum. 320+ GB preferred.
• Networking: Ethernet and Wireless Capable (802.11g minimum).
• Removable storage: Compact Flash, SD card readers optional.
• External Hard drive for local backups: should exceed hard drive capacity.

• Server Required for offices with 10 or more workstations.
• Operating system: Windows Server 2003 or 2008.
• Processor speed: 3 GHz, minimum.
• RAM: 8 GB preferred.
• CALs sufficient to cover all client computers.
• Hard Drive: 500 GB minimum, 2 TB Usable RAID 5 preferred.
• Networking: Gigabit network card preferred.
• External Hard drive for local backups: 2 TB preferred.

The hardware choices for office-based practices generally fall into two categories: stationary or mobile devices. The stand-alone architecture requires a mobile device.

Desktop computers are stationary devices that typically feature a box for the CPU with a separate monitor and keyboard. Desktops offer larger hard drive sizes, faster processor speeds, and you generally get more computing power for your money. The downside of desktops is that they take up more space than laptops or all-in-one units. Unlike laptops or tablets, they also do not have a battery which can act as backup power.

Price Range: $300 - $1000

All-in-one computers are similar to desktops in that they are stationary devices. However, unlike desktops, the CPU and the monitor are combined into one unit. This allows the computer to take up minimal space, and some may even be mounted to the wall. All-in-one computers tend to be a little more expensive than desktops, all things being equal.

Price Range: $400 - $1000

Laptop computers are popular with users that require mobility. They tend to be a little more limited in terms of RAM, processor speed, and hard drive capacity when compared to desktops. They also tend to be more expensive than desktops with similar features. Laptops come in a variety of sizes; screens typically range from 10 to 20 inches. Larger screens allow the user to see more information on the screen, but make the laptop more difficult to carry. Some people like to substitute the larger laptops for desktop computers.

Price Range: $300 - $1000

Netbook computers are basically like miniature laptops. They range from seven to 10 inches in screen size. Many of our providers feel that the screen size is too small for using EMR. However, we have had good results using them as miniature servers. Netbooks are typically even more limited in hard drive size, processor speed, and RAM than laptops. You can purchase a netbook for typically half the price of a laptop. However, the Windows Starter operating system featured on most netbooks is not adequate for HIPAA compliance.

Price Range: $200 - $500

Convertible tablet computers are a compromise between a laptop and dedicated tablet such as an iPad. They allow the user to operate in laptop mode, or flip the screen around and use the computer like an iPad. Most convertible tablets require the use of a stylus in tablet mode, but some offer touch-screen functionality. In terms of performance, they are similar to most laptops, however the screens tend to be a little smaller. Many of our clients love convertible tablets for their versatility, and the ability to maintain eye contact with their patients while in tablet mode. They also offer handwriting recognition which is great for medical staff that are not proficient typists.

Price Range: $500 - $1,300

XLEMR does not currently offer native applications for dedicated tablets, such as the iPad, or smart phones. However, you can access XLEMR from an iPad or Smart Phone through various remote desktop applications. We are working on a native version of XLEMR for the iPad. Please stay tuned for details.

Price Range: $400 - $900

Many of our clients and prospects ask if they will need to buy a server. The answer ultimately depends upon the size of their practice. Jonathan Wofford, one of our affiliates, weighs in on the question of whether a practice should use a workstation as a server:

First a pc is not a server, the operating system runs only to the benefit of the person using the main system, not anyone trying to run shared files or programs off of the machine. At the point you have 2 users on the box you are moving very slow, even with today's processors, at the point you hit 5 users the slowness alone typically quadruples the load time of any software or shared files on the machine. Over 5 users, the slowness is so unbearable that the client decides to purchase a server. Server operating systems are built to handle multiple users with multiple logons and distributes the work load accordingly.

Second, the life span of a workstation is that of 1 year. This is how they build them now. You can have a custom pc built that will last longer, but it won't make any difference because of how slow the machine will be running due to the operating system. Longevity with a slow system, unless you have 2 or less users.

Slowness and life span are more than enough reasons to not use a pc in a multi-user shared environment. I have had to deal with system crash after system crash on people going this route. Can it be done? Yes, do I recommend it? Nope, unless they like service calls. Which works great for me, but not usually for them.

Jonathan Wofford
Internet Marketing Associate
B & J Computers, Inc.
770-780-7107