Money can be tight when you’re starting up your medical practice or small business, and it can be very tempting to save money by buying cheap computers – but this decision can end up costing you more in the long run in terms of lost productivity and early equipment replacement.
TLDR; Buy the most powerful PCs (for stationary positions) and laptops (for “mobile” staff) you can afford, with the pro version of the latest Windows operating system (ie: Windows 10 Pro). Don’t worry about dedicated graphics – focus on getting the best CPU, with the most RAM and a solid state drive.
Here are some things to consider to help you buy the right equipment, keep costs down, but also future-proof yourself and improve your workflow.
Apple or Windows?
Windows. You’ll be hard pressed to find a server based EMR or practice management software that runs effectively on a Mac unless you’re using remote desktop or some other solution to connect to a dedicated server. Even web-based solutions require bridging software to talk to their peripherals, most of which will not work with Apple products. While there are ways around this, and it is certainly possible to have an Apple based office, save yourself a headache and the cost.
Do I need desktop computers if can we use laptops and tablets?
Straight answer – it depends on what you’re using them for:
For the reception, office manager, and other admin staff, which is an essentially stationary position, I would always go with actual PCs.
Check-in, and check-out positions tend to require extra peripherals to be connected directly to the computer such as webcams for taking pictures of the patients, signature pads, card scanners and credit card terminals. These all require extra ports to be available on the machines which laptops typically do not have enough of.
PCs also allow you the flexibility to have dual monitor setups which make working in an EMR considerably easier, especially when you have other programs as well. This increases efficiency, reducing the amount of time your front desk staff spends processing each patient.
It’s also easier to upgrade components in PCs than laptops which enables you to use the hardware longer and at a lower cost.
For staff who are mobile within the office, such as physicians, mid-levels, and nurses that are seeing patients, I would go with laptops.
Laptops are portable enough that you can bring them into the exam room with you and document while you are with the patient. I’ve seen this save between 5 and 10 minutes a patient allowing for a higher volume of patients to be seen during the day. It also helps prevent issues where a provider may forget to document something that was noted during the exam if they become distracted or are diverted after leaving the exam room and have to document later.
I wouldn’t use tablets. Tablets, while portable, tend to be underpowered and documenting on them tends to be considerably slower, even when they are equipped with a keyboard. – Sidenote – I’ve seen clinical staff almost cry when I’ve asked them to work on a device where the keyboard didn’t have a numeric keypad…
Use of tablets can also lead to issues relating to printing unless you take extra steps to prevent that.
Are you using a server or web-based EHR/EMR?
Server-based EMRs, whether the server is onsite or offsite, typically require you to install dedicated software on your computers in order to be able to use the system. In my experience, this software is typically enough to bog down slower computers, which reduces efficiency, and the requirements for this software only increase over time.
Web-based EHRs tend to have much lower requirements than server-based. Often all you need is a modern browser such as Google Chrome, Microsoft Edge or Firefox, and usually a small lightweight piece of software to bridge the gap between the browser and the peripherals.
Even for web-based solutions, I would caution against skimping here. Your PCs will have a lot of peripherals attached to them, many of which will also be running their own software. The combined load can significantly slow down older or less powerful PCs resulting in reduced efficiency, unhappy staff, unhappy patients, and reduced patient throughput.
What about my network?
Your network is definitely an area not to skimp on – all of your data, print connections, file shares, internet access, streaming audio and maybe even your VoIP phone connections will travel over your internal network so it had better be fast – although fast doesn’t mean that it has to be expensive. Gigabit switches are cheap these days, and every switch on your network needs to have gigabit capacity or you will create a bottleneck and slow things down.
Your router is no exception. I’ve seen offices with Gigabit networks hampered by poor or aging routers acting as both their firewall and DHCP server. For example, I was recently at an office that despite having a robust network was using an older Cisco Security Appliance as their router and DHCP server. The appliance in question could handle 40000 packets per second, which was causing a bottleneck and resulted in IP addresses not always being released or assigned (which meant devices were sporadically unable to connect to the network). Replacing it with a newer router for less than $300 increased the throughput to 2 million packets per second and alleviated the issues.
Don’t use domestic wi-fi equipment for your office or guest networks. They’re just not built to take the number of devices you’ll have connected to it. For example -let’ss say you have 7 laptops, 10 cell phones (that’s one for each member of staff – let’s be honest everybody wants to use work’s data instead of their own), 4 tablets (used for patient check-in), 2 streaming audio devices such as Sonos (it’s nice to have music that’s not muzak in the clinical area), and you’re already up to 23 devices before you even think about adding a guest network. Equipment such as Ubiquiti Unifi is as cheap as if not cheaper than many home wi-fi solutions but will be far more reliable with much higher capacity and allow for easier expansion.
What do I recommend?
Every situation is unique but in general, I recommend that you focus on interoperability, expandability, performance, and cost first.
The easiest way to achieve this is with Windows-based PCs. They’re relatively cheap, work with almost everything and won’t limit your choice of EHR or practice management solution.
When purchasing, focus on getting the best processor, the most RAM (8 gigs minimum but 16 would future-proof you) and an SSD (solid state drive). It doesn’t have to be a large SSD – 128 Gigs should suffice most computers as important file storage should be centralized and backed up. You could go with a traditional hard drive here if storage space was more important to you than speed.
Don’t worry about spending money on graphics cards – the integrated graphics chips on modern PCs are more than a capable of driving dual displays and anything the standard office environment can throw at them. Your staff should not be playing Fallout 4 on them.
Laptops should also fit a similar description, but the important thing here is the form factor and screen resolution. To get the most efficiency out of your EHR you’ll require a screen resolution of typically 1920 x 1080. Smaller screens will start hiding menus forcing you to click around more.
The form factor or size of the laptop is a matter of personal preference. Keep in mind that you’ll be carrying the laptop around all day, so lighter is better, but don’t get too caught up in it. Most laptops, even the larger ones with full numeric keypads, are light enough to tote around all day as most of the time you’ll put them down when you get in the room. An SSD is essential here though, as they have no moving parts which can help avoid damage which would occur to a traditional hard drive if there was a drop or bump.
Obviously, I haven’t covered everything that you need to think of here, such as implementing a refresh cycle, servers, on-site and off-site backups, redundancy etc, but I hope I have given you a good place to start.