New products address integration problems of smaller healthcare users
By BETTY GASCH
Healthcare InfoTech Contributing Writer
Software companies are in business to sell software and are often loath to become involved in the hardware side of the equation. It has never been profitable for software vendors to purchase hardware for the purpose of integrating software applications. Even if a company opted not to worry about the profit margin, software manufacturers do not have the manpower to adequately support the involvement necessary to truly support the incorporation of hardware with their products. Yet what happens to application reliability when they leave it to the hospitals to purchase hardware to run their applications?
It is the ultimate understatement to say that there is an incredible variety of hardware and software manufacturers and products available for hospitals and physician groups these days. Many of these products are supposed to be interchangeable, but for some of the products this simply is not reality. This is particularly true for the newer, 32-bit software and especially for Windows NT and the finicky hardware requirements associated with it. Any hardware developed prior to Windows NT does not include 32-bit drivers and thereby makes them incompatible with the Windows NT platform. And because Windows NT is not "plug and play," it is fairly hardware-specific. These two facts give rise to an unspoken "closet" medical application problem about which any large hospital or physician group is painfully aware. The problem is, who determines what hardware a group or institution will use to run the software that has been chosen? Also, how do you know in advance how well your new medical application will run on that hardware? If it doesn’t run well, who will the hospital call the hardware or the software vendor, or both?
Faced with this problem, some software manufacturers will evaluate a few hardware configurations, and then make general recommendations or generate a list of specific hardware recommendations. Then it is up to the hospital or physician group to purchase, assemble and integrate the software with the hardware. The problem with this approach is that vendors rarely are aware of the entire list of possible hardware solutions and usually list only a few of the tens of thousands of combinations that can be obtained. What if the vendors on the recommendation list are not be the same hardware vendors that the institution has already chosen to standardize on?
Institutions run into complex integration problems due to the fact that various systems will have been purchased at different times, have different processors, speeds, and amounts of memory installed. Some are configured for Windows 98 and some for NT. Since they all will be hooked together on a network of some kind, networking becomes a substantial issue. Because connectivity is not a simple task, it often requires a full-time network administrator to install as well as to manage the network on an ongoing basis. While some hospitals have substantial information system departments, physician groups have more limited resources and often cannot afford a full-time network administrator. But neither do they want problems such as lock-ups, device conflicts, paging conflicts or the dreaded blue screen of death, which, if it occurs on the NT server, can bring the entire office to a grinding halt. Physician groups especially do not want to take control of the hardware configuration required to assure that software applications run reliably in the increasingly networked medical office environment.
The two most popular network operating systems available for medical applications are Windows+TCP/IP and Novell Netware+IPX/SPX. Perhaps a third on larger commercial systems is Unix+TCP/IP+Samba. Partly because Microsoft is paranoid about market share losses to small competitors like Linux, it has addressed this network/hardware issue by offering a dedicated file/proxy server solution. It certainly was not the first to do so. Indeed, Compaq announced its Prosignia Neoserver Standard and Internet Plus solutions, and there have been a couple of others on the market based on Linux. Interestingly, Compaq was initially to be the designated Microsoft partner, but apparently made an alternative choice. Now Microsoft is partnered with Intel on this solution instead of Compaq.
The Microsoft solution, dubbed simply "Windows Terminal Server," is a turnkey solution, based on the forthcoming Windows NT 2000 operating system, in a custom version, which makes it much smaller and more nimble then the commercial version, which is in Beta 3 prior to release later this fall. solutions based on Linux as well as other non-Microsoft operating systems. This product is squarely aimed at small office environments which includes 208,000 solo and dual-practitioner practices in the U.S., as well as a subset of the other 19,500 larger physician group practices. It also should be popular as a departmental server for small hospital groups (from 15 to 25 nodes).
What is slick about these solutions from Microsoft, Compaq and others is they are smart and relatively self-configuring a sort of "plug and play" network/Internet office storage and file server solution. This takes the issues of what network cards (NICs), what processors, what speeds, how much memory, and which disks all out of the network implementation decisions. Microsoft and Compaq have chosen all of this, and integrated it into one slick package.
Typical capabilities of these products include file and printer sharing, automatic data backup, remote dial-in access, integrated TCP/IP hubs (usually in blocks of 8 or 16 ports), outgoing Internet access, and e-mail/e-commerce capabilities. Depending on the supplier, and the amount of storage and Internet connectivity inside, this turnkey solution will cost from around $900 to around $1,700 or lease from around $48 to $60 per month. That is pretty affordable stuff, and certainly a lot cheaper than a full-time network administrator. And these products should be more reliable than standard Windows NT 2000 or NT4 networking solutions, because in developing this product, Microsoft has taken out unneeded components of the operating system, and eliminated configuration choices which can misconfigure the network, or create network conflicts.
By adding some code to make the product self-configuring, what results is a plug-and-play network at least in theory. The test will be how they work in environments which mix Windows 95 and NT 4 with NT 2000, and which mix the security motif of NT with the lack of security of Windows 98, with a dose of NT Domain membership and privileges thrown in. If these products work as advertised, without requiring the user to answer dozens of configuration questions (many of which they have no clue about anyway), it will be a huge success and big cost-saver, and the answer many medical software companies have been looking for to the "What hardware do we get to run your system on?" question.
If these companies have done it right, one of the nodes could be a bridge or router that could link this mini-network server to another, and then it’s off to the network races, at a really competitive price. It all depends upon what devices these systems are preprogrammed to recognize, which can be attached to the network. If the medical vendors use their gateway products to connect to these networks, and add a little device to HL7, DICOM, or ASTM protocol conversion, medical networking applications could become as simple as ordering dinner at a Chinese restaurant, picking one from column A and one from column B.
But it may not stop there. At this street price, these mini-network servers might be configurable as cheap redundant file servers, and embedded in medical application products as cost-effective, mini-data repositories. This could help to lower the price, and reduce the development time to bring new Windows applications to the market, lowering their price as well particularly for the many software suppliers smaller than IDX, SMS and HBOC. Indeed, the software might even be delivered pre-installed on such servers, which is really how the hospital wants to purchase it in the first place. So while the hospital information network will still likely require a network administrator, their task of building and maintaining such networks may be made simpler by these types of products.
While the Compaq (Houston) solution is being offered now, and the Microsoft (Redmond, WA) solution won’t be available until August, the Microsoft Market Machine is likely to convince the faithful that it will be better to wait and get a product based on Windows NT 2000 than to get a product today from Compaq or some other supplier which may become obsolete in less than six months, when the desktop version of NT 2000 comes out for real. One would also expect that the Microsoft product might work a bit better with Windows NT 2000 when it does arrive than does a product developed by a competitor which doesn’t have access to all the inside workings of the new Microsoft operating system.
The beta version of this software went to build about 10 days ago, so medical application vendors probably can contact Microsoft now to become part of the beta test and get some firsthand experience, before their customers do, about the quality and reliability of this product. They then can make intelligent recommendations to end users about which of these plug-and-play network server products will be the best ones to purchase to run their applications.
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