| Doctor prescribes Linux for more reliable networks, lower cost |
(Nov. 3, 2003)
DesktopLinux.com talks to CEO and physician Dr.Martin Echt about his decision to move his 200-user network to Linux-based thin clients. The NY medical practice's conversion to Linux has improved performance, reduced costs, and increased stability. Capital Cardiology Associates' (CCA) cares for over 40,000 patients, makes 40,000 hospital visits, and performs more than 30,000 diagnostic procedures like open heart surgery in 6 offices and 8 hospitals. The decision to move met stict requirements to accomodate all levels of users, delivers secure exchange of information, and was easily introduced into an existing system.
After commissioning a feasibility study, Dr. Echt concluded Linux thin clients were his company's long term strategy to counter rising licensing costs and would scale to meet future technologies. With system integrator Lille Corp. onboard to facilitate the move from Microsoft to Linux, CCA has realized cost savings. Hear the practical reasons why Dr.Echt picked Linux.
Q: What were the main reasons you opted to switch to Linux thin clients in your organization? You opted to use systems integrator, Lille Corp. and freely available open source software from a variety of projects? Can you explain the configuration you selected?
Dr. Echt: You need to know first that I have always been a Unix fan and Linux, with it’s open source was a logical next step. Business-wise, open source leads to the availability of tens of thousands of programmers which makes rapid development of open source software applications much more likely. In addition,having used Unix for a Medical Practice Management Software (MEDICAL MANAGER) I have been very impressed with the stability of Unix version V. Two years ago I had Paul Beltrani come to Albany to do a feasibility study on conversion to Linux from Novell/Windows. At that time he basically recommended against it because there were too many application program issues and incompatibilities. Our medical practice had expanded very rapidly in the last 5 years and last year in August I recruited John Hammen to again do a detailed onsite feasibility review.
This time I was presented with a basic design layout to integrate about 80% of all our functionalities (Billing – Unix-based), net worked Word processing – spreadsheets (Ooo), email, electronic medical record (e-Scribe – Oracle, Internet-based) into one coherent net for six offices plus seven hospital locations, all able to access all of the above plus management data.
With that report, we looked for a Linux vendor –- and there were no commercial vendors for this kind of development project. Thus we entered into a 6 months business agreement with Lille Corp, our current vendor for EMR. A migration plan was worked out that included support costs for the program.
The configuration we selected was based on the recommendations of Lille Corp. I am not a technical expert, but in a nutshell, we use 'sendmail 'as replacement for MS Exchange. We selected LDAP (lightweight directory access protocol) so that we could centrally manage users (LDAP is simply a database for storing anything such as usernames, passwords, flags for things like creating a new home directory, etc.).
In CCA we have a single userame and password good at any site. To gain speed, all remote sites maintain on their site server a cached copy of the central LDAP server. We chose Evolution to replace Outlook. Webmail for remote, simple access (SquirrelMail). It allowed us to use the shared calendar capability in Squirrel and really works fine, meeting the needs of the docs who constantly need to check their assignments. We selected a minimalist window manager, (Ice windows manager (ICEWM). The critical criterion for this last choice was the decision to give our users just what they need -- No extra menu selections, no heavy desktops filled with features and functions that can only hurt performance or create instability if used improperly. Complexity is the fertile ground for instability.
We initially used the Konqueror file explorer and while KDE is considered the most user friendly desktop our Lille Corp. specialists recommended otherwise. We are currently switching and going to be using 'ENDEAVOUR MARKII' to replace the Konqueror file explorer. We are using Hyla Fax said to be industry standard in Linux/Unix world I am told. Everything I have mentioned I believe is 100% open source. We use NFS for access to remote filesystems.
To block spam, we use Spam Assassin, SAMBA for the MS Terminal Server, instead of CITRIX. file storage and printing. We use CUPS for Linux printing, Mozilla for Internet browing and a Linux-based Citrix client for access to other Citrix farms such as access to the datasystems of several hospitals. We use Xterm for connecting to Medical Manager (a UNIX-based practice management program).
Why did we select the thin client? If we had selected Linux and CITRIX desktop solution, the project would not have been economically viable at this time. While us going to Linux was driven by many other factors, it still needed to be economically within bounds. Thin clients accomplished that.
We use LTSP (Linux Terminal Server Project). And other programs to help in keep system admin costs down and issue tracking.
Q: Were you able to find all software you needed for your organization in the open source community? Did you make any concessions or lose any capabilities? Did you gain any features?
Dr. Echt: I We have a lot of proprietary software, and the main challenge was to integrate the apps as much as possible into the network.
Over 90% of our work is done on MEDICAL MANAGER, e-SCRIBE, MS Word, and MS Excel. We switched to OpenOffice.org (OOo) and all of the above run perfectly --- and we are a very large medical group, over 40,000 office patient visits, over 40,000 hospital visits, over 30,000 diagnostic procedures, including open heart surgery. So the nuts-and-bold are working fine. NO CONCESSIONS MADE.
There are, however, a few wrinkles in the Ooo spreadsheets, most notably their graphics and the lack of checks for simultaneous use. Loss of data has occurred due to lack of appropriate write and save protection.
Some of our proprietary specialty software (KRONOS, ADP, MAS-90, ABRA, BNA, FRX, LOCKBOX -- employee time sheets, payroll, accounting programs) did not run that well initially. It was difficult to get help from the vendors because most of the time they simply had zero experience with Linux and just didn’t know. In addition, there were not going to waste their time without new sales. So, after initially trying to access via Windows Terminal Server, we switched a few dedicated systems back to Window to accomodate those applications. In addition, there are specialty program apps which are free standing and not network designed (like a pacemaker check program). We simply left them alone.
We used MS ACCESS and have yet not decided on what open source app to chose.
Currently, we are are distributing OpenOffice.org CDs to all document and administrative users so that they can use OOo on their MS home computers.
Did we gain any features? Not yet -- but there is a significant difference in file size for the same data , especially for the spreadsheets. Open office spreadsheets are only 1/2 to 1/3 of the size of MS Excel!! That difference in size make a huge difference when networking and working on files via T1 or Cable VPN!
For the future, we wanted to be ready for handheld devices or tablets to interact with the thin client, and embedded Linux will make that easy and beautiful.
Q:How has the transition to Linux gone?
Dr. Echt: The transition was a bit slower than planned. We made – in hindsight – a strategic mistake in trying to switch to Linux from Novell/MS “on the fly.” That is, we did it while all business functions were ongoing. We did not invest from the onset into a testing environment server setup. Thus, most of the work needed to be done at night and weekends, and often the glitches showed up at 8 AM when the office staff arrived and powered up their systems. This was a bit painful at times and could have been totally and easily avoidable with the proper initial testing setup. My integrator, Lille Corp. advised to invest into a testing-server. I wanted to “save” money and I didn’t in the long run.
Q: How has your staff responded to the change?
Dr. Echt: The receptionists, billers, check-out people etc. all did fine. They are mainly using billing. No problems. There were some hiccups due to occasional problems with data transfer speed but we had no loss of productivity.
The managers and the docs had some issues -- our initial e-mail system was PINE, and that went over like a lead balloon. Talk about taking something away! (I am an old DOS freak and I liked PINE and I chose it myself). That was a big mistake. Once Evolution was in, the uproar was over. Lesson learned: “userfriendly” e-mail is critical.
OpenOffice.org met some resistance because people just don’t like anything new. But oncet hey understand – no problems. Except many complex Excel graphics (bar graphs and that sort of stuff) do not convert well to OpenOffice.org. In addition, the colors are different and sure freaks some people out!
The bottom line is that if we had used Evolution from the beginning and if we done better training on OpenOffice.org it would have been a bit easier.
Q: Have they provided any feedback on ease of use?
Dr. Echt: Yes, our billing and practice management software works better and is very stable. Feedback very positive overall. We had some problem areas at first, we needed quite some tweaking to optimize our network configuration and get fast enough file and transfer speeds due to the common complaint of “it takes too long”). That has been resolved.
But, having been CEO for 18 years, I am used to the effect of change on people. It takes time – and when the innovation is truly better than the previous status, employees will come around. Some faster than others.
-- continued --
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