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Ubuntu Doctors Guild

Contents


Ubuntu/Kubuntu Guides

(The editor of Ubuntu Doctors Guild is also the author and editor of these guides.)

Ubuntu/Kubuntu Server guides

Electronic Medical Records (EMRs/EHRs)

  • Ubuntu-Med is a customized Kubuntu Server (created by the author of Ubuntu Doctors Guild) which includes the Astronaut OpenVistA EHR . Install it yourself or let us help you.

Others:

EHR certification

Electronic Prescribing (Outpatient)

National Health Identifiers

National Health Information Exchange

Regional Expertise "Extension" Centers and Networks

Using VistA in a Health IT curriculum

There currently are several grants available to set up Health IT training curricula, at the university level, at the community college level, and as "Beacon Communities" (i.e. local expertise and training "extension" centers). Astronaut VistA allows an entire EHR simulation to be set up for free in a computer lab of a training institution or expertise training center. There is no other complex and comprehensive EHR system like it available for training (that is also free). See Ubuntu-Med.

Solving problems related to networking, mobile access, security, access controls, interfaces with other systems (labs, PACS, etc.), health information exchange, and other common EHR "learning curve" issues can be done in a lab environment before a health IT student goes into the "real world" to work with production installations (whether VistA or other EHR systems).

Combined with a distance learning package that includes distance learning (using the free online-curriculum products Moodle or Claroline, for example), screencasts, webinars (using free products such as BigBlueButton, WebHuddle, or DimDim), and remote access to VistA servers in the teaching computer lab, a comprehensive Health IT curriculum even for remote students can be established. Here is a demo site of this (that also has an integrated BigBlueButton teleconferencing capability).

No other EHR allows this flexibility. Further, teaching resources can be shared freely with other educational institutions, expertise extension centers, the VA health system, and the rapidly growing number of hospitals, clinics, and practices installing VistA.

Because VistA uses the MUMPS database, which is also used in EPIC and GE Centricity (to name a few), education using VistA in a college curriculum is transferable to other EHR implementations, as well.

Telemedicine

Software How-tos

Groupware

Wiki software

Website server

Webinars, Teleconferencing, and online Group meetings

Office Security

Online health information resources

Other open source health care software

Imaging software

Online resources

Advocacy groups

Hardware

Racks

Blade server racks

Servers

A server is a software program. It has become standard to refer to a computer that hosts the server software as a server, as well. The type of server software that is running dictates how powerful a computer is needed to run it.

For example, I am running a wiki farm, a groupware server, a DNS server, and 4 website servers on a single PC (using the Ubuntu Server OS and open source server software as detailed in this guide). All of this runs on a tower eMachines PC that I purchased at Walmart for about $400 (dual core 64-bit 2.7 GHz CPU with 6 Gb RAM, 750 Gb SATA harddrive) or this one from Newegg, to which I merely added extras harddrives for RAID capability. This "server" hardware is very fast for the needs of our small hospital (for these purposes) and in fact is superior to many entry-level commercial hardware "servers".

A DNS server or VPN server (e.g. OpenVPN) can even be run using an old discarded PC, in fact, because these types of servers do not have high computing requirements.

On the other hand, our electronic medical records system has millions of database transactions, and robust server hardware is desirable. (Even so, WorldVistA (as well as a few other EHRs, like Epic) uses a very efficient database (GT.M Mumps), so top of the line server hardware is not necessary even for this.) Terminal servers which may have many simultaneous users should also have robust hardware.

Hardware becomes outdated in about 3 years, so don't be tempted to buy the top-of-the-line hardware. Your money will be foolishly spent and you will regret it in 3-5 years when you are upgrading your equipment. The money that can buy hardware suitable for hosting 4 (software) servers today will buy hardware capable of hosting 16-32 servers in about 3 years. Be frugal.

Rack servers

Most "server" hardware is sold without a server operating system included. Windows 2008 server software adds about $800 to the purchase price of each unit, whereas an Ubuntu Server operating system is, of course, free. Specific server software (as detailed in this guide) is free for Ubuntu, but each server software package for Windows is also additional (and variably priced).

Blade servers

Desktops as servers

For "low-cost" hardware, there is no match for an inexpensive desktop system. You will find superior capabilities in a desktop for a price about 20% of the price of similar hardware packaged in a rack-mount case. Further, there are server racks on which you can place multiple tower or mini-tower cases. This solution is ideal for small clinics and physician offices, which usually do not require an entire data center.

The primary requirement consideration for such hardware is the number of hard drives that can be mounted in the case. RAID 5 needs at least 3 hard drives, so the ability to mount at least 3 drives in the case is important. Many mini-tower cases only have space for 2 hard drives to be mounted, which limits you to RAID 1. Of course, if you will use a separate storage device (such as a network-available RAID storage device, NAS), then this is a moot point.

Storage

Every system fails. Always use RAID failsafe capabilities. Every server should have a minimum of 2 hard drives (for RAID 1 failsafe reliability) for use by the operating system. All other storage on your system can be provided by external storage, such as by a network attached storage device (which can be RAID 5 capable), or by a (more expensive) SAN (storage area network).

Network attached storage

Connectivity

Clearly the size of your organization and the amount of data you intend to move around the network will dictate how much money you will spend on switches and connectivity. Gigabit-capable switches are inexpensive and are the minimum for today's data requirements.

Jumbo frame support is desirable for switches used within a SAN, since data can be moved around between the devices faster this way. (The normal data packet is around 1500 bytes (MTU). Larger, or jumbo, data packet sizes (around 9000 bytes) allows data to move faster around the local network using fewer packets per transmission.) Note, however, that all devices within a subnet must all be using jumbo frame packets (i.e. all set to the same MTU), and jumbo frames are not the standard for Internet transmissions. Therefore, jumbo frame support is useful only for small subnets (such as within a storage area network).

VLAN (Virtual LAN) support is desirable if your organization has several remote sites, each with its own LAN, that you wish to be connected by VPN tunnels and be able to communicate as if they were on the same LAN. This is a highly desirable function if your organization is likely to grow in many physical locations.

Switches

FiberOptic connectivity

FiberOptic cables provide the theoretic highest rate of data transmission (speed of light). As with all systems, the switch is often the limiting factor.

There are basically two types of fiberoptic cabling. Multi-mode fiber (used for 850 nm and 1300 nm wavelengths) is useful for relatively short distances (up to 600 meters), whereas single-mode fiber (used for 1310 or 1550 nm wavelengths) is better suited for long distances (tens of kilometers). Within an institution, multi-mode fiber is generally used, whereas the single-mode fiber is generally used by telecommunications companies or for longer distance connections.

Two locations separated by a limited distance can therefore be connected by multi-mode fiberoptic cables and merged into a single network. A fiberoptic switch ("multi-mode fiber convertor") is required on each end.

Small office routers

Institution specific

Hospitals

Large clinics

Small clinics

Small practices

Networking

Networking Basics

Backup

This is the importance of open-source solutions. To have a test system and a production system is very expensive if you must pay for two (or more) databases and software platforms. However, it is very economical if open-source databases /systems are utilized. Further, backups / redundant images / offsite redundancy are facilitated when databases / systems can be replicated.

Very few small clinics / hospitals / small to medium practices are likely to consider this failsafe, but it is an important one that can make or break an institution in the long run. Always plan for a disaster. Be prepared.

Resources:

Remote Access

Terminal Servers

DNS servers

Other Pages

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