information technology

Considering New Technology?

Look Before You Leap

JOHN WARREN, O.D., Racine, Wis.

Compatibility is your chief concern when purchasing new software, diagnostic equipment or a new computer altogether.

Technology is a double-edged sword. You need it to make your practice run smoothly and provide the best patient care, but at the same time what is deemed the latest-and-greatest today, is yesterday's news almost the second you hook it up. This makes technology a money pit, and incompatibility can deepen it.

Unfortunately, many computer users aren't aware that their machine's operating system (Windows 98, 2000, XP, Vista and Mac OS X) and hardware dictate what software (programs) and diagnostic instruments will and will not run. So, they purchase new software and diagnostic instruments only to find that they're incompatible with their computer or the computer's operating system. Or, these users purchase a new computer only to discover that the software and diagnostic equipment they've come to depend on won't run on the new machine. The outcome: empty pockets and a room in your practice that resembles a computer graveyard.

To avoid this, you need to educate yourself on your personal computer's (PC) operating system, six components of computer hardware and how both are intimately linked with software, such as practice management (PMP) programs and Electronic Medical Record (EMR) programs and diagnostic equipment. (For more on EMR, see "EMR: The Real Costs," page 28.) I won't be discussing Macs due to their minimal market penetration, especially for diagnostic instrumentation.

Operating system

The operating system is the backbone of your computer's software. Without it, none of the other pieces of your computer will run. When considering the purchase of a new software program or diagnostic device for your current computer or using an older software program or diagnostic device on a new machine, look at the each product's system requirements. You can usually find these requirements on the manufacturer's Web site or on the packaging, if it's a mass-market device.

Let's say you're interested in a PMP that requires Windows 2000 Professional (minimum) or Windows XP Professional (workstations); and a Windows 2003 Server, a central storage device (recommended). Also, a corneal topographer that requires a choice between the same operating systems has caught your eye. If your current computer doesn't have either of these operating systems, you will most likely need to purchase a new computer to utilize either one.

You may think you can just buy a new operating system and upgrade the current computer. While this may be possible, the hardware may not be sufficient to run the new operating system well. As companies release new operating systems, hardware improves greatly from the hardware created to run the previous operating system. This means that the new operating system will perform poorly on the old hardware.

You may consider upgrading your current machine's operating system and the computer hardware. Still, other than upgrading Remote Access Memory (RAM) (see below), upgrades can be somewhat difficult, time-consuming and expensive.

Before you purchase a new machine, be aware of these issues:

► Almost all new personal computers come with the Windows Vista operating system. This means that even if you purchase a new computer, it may not be compatible with the new PMP and topographer you're considering. In fact, many diagnostic devices and some software have not been well tested and may not be compatible with Vista. Devices utilize what are called "drivers" to allow the operating system and programs to interface with them. Many older devices may not have, and may never have, drivers written for them under Vista. When a new operating system enters the market, most business-producing hardware won't declare their equipment compatible or supportive of the operating system until at least the first major upgrade, if ever.

► Get recommendations from your device and software vendors. If you decide to order a custom PC that has Windows Vista, or "downgrade," consult the experts.

Hardware

Computer hardware refers to the tangible objects of your computer. (See "Computer Terminology," page 40 for definitions of bold terms.) Without proper hardware, software won't function, and the best hardware without software is just an expensive anchor.

If you determine that the PMP and/or diagnostic equipment in which you're interested is compatible with your operating system, you must also make sure your computer's hardware is compatible with the PMP's requirements prior to purchasing the software. Here's an overview of six key pieces of hardware:

Upgrading the processor usually yields minimal gains in performance.

► The central processing unit (CPU). This is the computer's "brain." It's responsible for handling all the instructions from other hardware components in the computer and the software that run on it. If your computer doesn't have a product's minimum or recommended CPU requirement, you could upgrade the processor, but the gain in performance is often minimal, as a significant increase in processor speed usually requires updates to other hardware, such as the motherboard (the large circuit board to which all the components are connected). In other words, it may be in your best interest to purchase a new machine.

► RAM. RAM refers to the memory used to run software. RAM allows you to work in several programs at once, so you can seamlessly click from one application to the next without having to close the previous ones. Therefore, the more RAM a computer has, the more it can do at once. Different types of computers require different types of RAM, both the speed of the RAM and the physical connection type. The computer manufacturer's Web site will tell you what type and how much RAM your computer can use.

If your computer doesn't have the minimum or recommended amount of RAM, check with the hardware's manufacturer to determine how much RAM your computer can use and with what type of memory chip to upgrade, if possible. In many cases, you'll end up removing smaller chips that came with the computer to add one or more larger chips. An example of this: Removing a single 128 megabyte (MB) chip to install two 512MB chips. (These numbers are only examples. Standard workstations typically have 1 gigabyte [GB], power stations typically have 2GB and servers typically have 4GB).

► Video card. The Video Card, or Graphics Adapter, produces the image you see. Some optometrists choose to upgrade this hardware component to improve the performance of retinal and slit lamp imaging systems.

If you're able to run your PMP on Windows 98 or Windows 2000, chances are your video card is just fine. Software designed for Windows XP and the forthcoming programs for Windows Vista require fast video adapters and more Video RAM (the memory dedicated to video processing) to run.

Many entry-level computers come with a video card as part of the motherboard. These computers may also have a mechanism with which you can disable the video card to place a higher-grade card in a slot on the motherboard. Not all computers have this mechanism. Therefore, contact the manufacturer of your computer, or check their Web site and/or computer's documentation to see whether it's possible to upgrade the video card.

► Hard drive. The hard drive is where you store all your operating system files, software and data files. Hard drives now contain hundreds of GB. In fact, for the last four to five years, hard drives have been at least 40GB in size, and several computers come with 80- to 250GB hard drives. Also, some new server-class machines boast terabyte hard drives.

If hard-drive space becomes an issue, you can either upgrade the current hard drive or add an external one. Universal Serial Bus (USB) connectors are very common, but slower than an internal connection. A FireWire connection is faster, but most PCs don't have them. You can add a FireWire connection to most computers, but once you get to that level of upgrade, you may be better off swapping out the internal hard drive for a larger one.

If hard drive space becomes an issue, upgrade the current hard drive or add an external one.

► Network Appliance Servers (NAS). These are storage devices that you can access over a computer network (usually Transmission Control Protocol [TCP]/ Internet Protocol [IP]), rather than directly being connected to the computer (internal hard drives or external USB/small computer system interface [SCSI] drives) and are used as file servers. NAS devices enable multiple computers to share the same storage space at once. A big advantage: If you need more storage space, you can add another NAS device and expand the available storage. NAS also brings an extra level of fault tolerance to the network. These devices often contain more than one hard disk drive, often arranged into logical, redundant arrays of independent (or inexpensive) disk containers or RAID arrays for added redundancy/security — thus protecting data in the case of disk failure. Some NAS devices accept USB external hard drives to which you can run backup. NAS is a great option for storing and archiving patient data, but adds a layer of network support you may or may not be willing to take on or pay for.

► Network adapter. This enables your computer to link with a group of two of more computers. Keep in mind, however, that between two computers, the connection is limited by the slowest adapter.

Wireless adapters have become quite common in notebook computers and even in some desktops. They come in 802.11B and 802.11G and a third that is awaiting standardization, 802.11N (from slowest to fastest, respectively). All three can coexist on one network, but again, the connection speed is limited by the slower adapters. Check the Network Adapter requirements of the software and diagnostic device in which you're interested, as well as your computer prior to making any purchases.

Remember: Before you buy new software, diagnostic equipment or upgrade your current computer, make sure these new items are compatible with your machine's operating system and hardware. And, should you decide to purchase a new computer, determine whether you'll need to sacrifice any of your current software programs and diagnostic devices as a result. This will enable you to keep a balance between upgrades and performance and preclude you from plummeting even deeper into the money pit that is technology. OM

Dr. Warren is in private practice in Racine, Wis. Contact him by e-mail at jwar renod@gmail.com.