Successful implementation of new practice-management software depends on the quality of your hardware systems.

Congratulations! you have a successful physical therapy practice that is growing by leaps and bounds! A constant flow of patients is keeping you and other staff very, very busy. Maybe the workday is a little bit too busy. In fact, if you want to continue to grow without stressing yourself out, it’s time to start thinking about ways to streamline your processes and make your practice more efficient. Software vendors would love to set you up with a practice-management, scheduling, and/or and electronic medical records system that can help ease the pain of day-to-day workflow. Software features can vary widely, but all software systems have one thing in common—they require computer hardware to function.

You can take several different approaches when purchasing computer hardware, depending on the size of your practice and the software system you purchase. The purpose of this article is to cover some hardware basics that apply to all types of practice settings, and also to examine some special considerations for multiple-practice operations.

Size Matters
First, let’s define a few practice settings and make some suggestions for those that might be “shopping around.”

Single Practices (The Army of One)
This office does everything from start to finish. In one building, various staff members make appointments, treat patients, handle documentation, and get the billing out the door. The very nature of doing everything in one place creates a mind-set of “do more with less.” A common mistake made at these single practices is to load up a single computer at the front desk with every program that might be needed, resulting in performance issues and a single point of failure.

Multiple Practices with Two to Five Offices
At this organization, some of its functions may be centralized. For example, administrators may take care of billing and financial issues. If good systems are not in place, there probably will be a heavy paper trail and some exhausted fax machines.

Multiple Practices with More than Five Offices
This company has, most likely, already centralized most functions, leaving clinic PTs to do what they do best—treat patients! They probably have an information technology (IT) staff—or at least consultants—who help with computer issues, and they might have some legacy systems in place.

Hardware Essentials
All of the above groups require some common elements to make things run efficiently. Even the large, multiple-practice physical therapy company will have smaller offices with similar components to what the single physical therapy practice might use. The following are key pieces of hardware that every office should have.

File Servers
The file server is the core of your small network design. A file server is not a computer that your staff uses directly from day to day; its job is to sit quietly off in the corner of your office somewhere and hold all of your most critical data. All other desktop or laptop computers in your office will use the file server for network connectivity and secure access to the data most vital to your business operations. The use of a file server allows you to be very specific in controlling who has access to what patient data.

Typically, a server contains at least two identical hard drives that are mirrored, meaning the drives are redundant and contain a complete copy of the other drive’s contents. Any data that gets written or saved to one disk will also be written or saved to the other. You should also have a plan for off-site data backup so that if a disaster (natural or otherwise) occurs that destroys the file server in your practice and both disks at the same time, you have a copy of your data that can be restored to a new system.

Desktops and/or Laptops
Desktops (also known as PCs) and laptop computers are the day-to-day workhorse machines. Business use does not typically call for fancy 3-D cards, sound cards, etc, which you may purchase for a system in a home. You can purchase a very good desktop for approximately $800 and complement it with a nice flat-screen monitor that is easy on the eyes for another $300. Laptops tend to be a little more expensive ($1,500), but they give you the freedom to move around the office and take much less space than the stationary desktop.

When choosing these machines, remember that the memory (also called RAM) is a more important feature than hard-drive space. A computer with more RAM is able to run more programs at the same time and maintain an efficient rate of speed. The Windows® XP operating system, for example, will use at least 128 MB of memory all on its own before opening any other programs on a computer. In today’s computer market, a new computer should have a minimum of at least 512 MB of memory. Again, hard-drive space is not as important for most medical-office settings. A typical computer system sold today will have a 40-GB hard drive as a minimal configuration, which is more than adequate for an office desktop. Workstations like this are so inexpensive, it really is worth making your life (and the lives of your other staff members) easier by spending a few hundred dollars and keeping the systems current.

Tablet PCs
Tablet PCs are noteworthy because of the type of software you will be considering in health care settings. A tablet PC is mostly a laptop, but it is defined by a touch-sensitive screen and a stylus for entering information. Therapists look at these and think, “Wouldn’t that be great!”

The tablet PC has the potential to be great, but the end-user should be aware of a few limitations: First, using a stylus to enter data instead of the classic keyboard-and-mouse combination means your software system must make good use of pick lists and check boxes. Second, if your handwriting is bad, it is not likely to improve on a touch-sensitive screen. Therefore, the use of the handwriting-recognition functions with tablet PCs can be a source of user frustration. And lastly, batteries are the heaviest component of most portable electronic devices, and tablets need to have a long battery life.

Be aware of the weight of the unit that the therapist will carry around all day. Every year, portable devices continue to improve, and if the computer industry doesn’t give up on the tablet PC, it could still have a bright future in health care. Currently, the tablet PC falls into the “close, but not quite” category for most real-world applications.

Broadband Internet Connection
Almost every populated area now has access to a high-speed Internet connection. Broadband Internet connectivity allows remote support options for any software you might be using. In fact, most major software packages offer regular updates online. If you run into trouble, the broadband link allows a technician to help you out over the Internet with no office visit necessary. You can also use it to perform off-site data backups.

Larger groups could use a broadband connection to create network connections between offices.

Hardware Firewall
You should not connect to the Internet full time without protecting your network. A firewall is either a hardware device or a software product that sits between your Internet connection and the file server and filters out bad network traffic.

Hardware firewalls are preferable in most business settings. One advantage of hardware firewalls is the ability to create a virtual private network (VPN). This feature allows the firewall boxes in two locations to create a network link between them using the broadband Internet connection.

A VPN is a cost-efficient way to link facilities together and share network resources. A software firewall is a computer program designed as a secondary protection for individual computers and is very different from a dedicated hardware product.

Backup Systems
A foolproof backup system, while seemingly a simple piece of your network design, can be equal to the worth of your entire practice in the event of a disaster. Pay attention to it! For many years, backing data onto tapes or hard drives, and then storing the media off-site, was the best protection against disaster. Recent high-profile news stories have shown that when the off-site data falls into the wrong hands (stolen from the IT guy’s car), you had better hope it was at least encrypted!

Consider using an online backup system that sends your data overnight to a secure facility. These facilities are set up like a military defense bunker and are much more secure than the average glove compartment in a car. Automatically backing up data in the middle of the night is also more reliable than a staff member who must remember to “switch the tape” every night. Online storage is sold by overall space required, and when the cost is spread over multiple facilities, it’s very reasonable. If online storage is not an option for you, the use of removable hard drives instead of tape systems is another option. Hard drives are more reliable, and restoring information from a hard drive is much quicker than winding a tape.

Support for Software
How does this relate to the software being considered? Now that we have examined a basic network design, here are some questions that you will want to ask potential software vendors so you can narrow down your hardware needs.

What are the minimum hardware requirements for the program to run? A minimum hardware requirement means the program will run, but not necessarily at its best. You should purchase hardware that, at least, doubles the minimum requirements. You can prepare for future software patches with higher requirements and general operating-system updates that will demand more from your computers by purchasing systems with greater capabilities now.

Is the software going to be installed on your local file server, or is the software going to be hosted off-site? If the server holding the data is not in your same physical building, pay close attention to bandwidth requirements. The network link between your computers and the server inside your building can move data much faster than the link between other physical buildings. Check the actual speed of your broadband Internet connection. You can test for upload and download speeds with free online tools like the one found at http: //www.dslreports.com/stest. Notice that upload speeds (data speed leaving your building) can be considerably slower than your download speeds. Make sure that your connection will meet your needs.

Unique Considerations for Multiple Practices
Depending on the company environment, you might have a dedicated IT employee for every facility (yes, they are out there), or you might have three people supporting 60 offices. Here are a couple of things the three-person team will use to streamline support and keep the PTs within each facility happy:

1) Standardize on a computer vendor. The technical guys need to know what they are working with. If you keep machines similar (ideally, identical) from site to site, you will have less guesswork and possibly a small pile of parts readily available for quick repairs.

2) Budget for a hardware life cycle. If you do have a single IT staff member for every office, what does he do all day? Most likely, he continues to repair machines past their practical usefulness. Consider planning to replace your computers every 3 years. Software products improve with more features and usually get more power hungry each year. You can keep machines alive by putting fresh parts in them—resulting in a working, yet still slow, machine; or you can spend the $800 on a desktop every third year and keep up with the times.

3) Connect it all. A VPN allows you to connect all of the offices centrally for very little cost. This allows IT support—such as installing software updates as necessary—to be administered remotely. Software updates can include critical applications beyond practice-management systems, such as antivirus, operating-system updates with the latest security patches, and backup utilities or reporting packages. Use the connections to centralize as much as you possibly can!

Security Considerations
Once everything is standardized, connected, and streamlined, what else is there to worry about? Between the Health Insurance Portability and Accountability Act (HIPAA) in the health care environment and the growing problem of identity theft, data security is the one area that will cause IT managers and physical therapy facility directors to lose sleep. In an ideal medical setting, all important data is stored on your file servers, in a well-protected, central location. It is important to evaluate if other critical data—or, in the case of HIPAA, patient data—is being stored on desktop or laptop computers. Laptops have a way of disappearing more easily than any other type of computer.

Here are a few more security considerations:

1) Do not even consider setting up a wireless network in your practice unless you know how to configure it. Take a walk down the street sometime with a laptop and note how many unprotected networks pop up. Many people purchase wireless gear, take it out of the box, plug it in, and it works … so why mess with the configuration? Don’t be one of those people. Security is not enabled by default on wireless equipment. Consult with someone who can help you configure the appropriate security settings for your wireless network. Wi-Fi Protected Access is a security feature that should be used with the longest, most random shared key possible. In fact, those reading this and using wireless at home should review those setups, too!

2) If you use Windows XP, you have encryption available. Use it on laptops. While the use of encryption is not enabled by default on most systems, you can encrypt important files and the folders that contain your most critical data files with a couple of clicks. Encryption does make it harder to restore the data if something goes wrong with the disk. (This is one of the main purposes of encryption should your data fall into the wrong hands.) However, if you regularly back up the laptop, this should not be a big concern. At least if the computer disappears, it is not open season for the thief!

3) Schedule automatic spyware scanning. Assume that your employees are going to browse the Internet with your business computers. The simplest of searches can potentially send them in the wrong direction. Spyware applications are usually bundled as a hidden component to downloaded programs. The purpose of spyware is to monitor user activity on the Internet and send information to its creator. The malicious versions try to capture e-mail addresses, passwords, or other data. Spyware loads in the background and can sneak under just about anyone’s radar. If you leave machines on at night to allow software updates, add spyware scanning to the routine. Many network issues, such as a slow response from systems, can be tracked back to bandwidth-hogging programs that run constantly behind the scenes.

The tips listed in this article serve as a broad overview of computer hardware and network topics to consider when evaluating new software solutions, or evaluating the existing computer system within your facility. Each topic can be researched in much more detail on the Internet with some simple searching.

Never hesitate to ask as many questions as possible before settling on a software solution. Most vendors will be more than happy to walk you through all of the requirements and make sure you end up with an efficient system. Follow up with references of satisfied customers before signing on the dotted line.

Jeremy Bennett is the information systems manager for Therapeutic Associates Inc (TAI), a private, physical therapist-owned rehabilitation company that operates more than 60 outpatient facilities and contract sites in the Western United States. Bennett has worked for TAI for 10 years, and with the help of two other staff members, he currently supports 55 outpatient clinics, three administrative offices, and more than 400 computers spread over four states. Todd Gifford, MSPT, is a part owner and the director of information systems at TAI. Gifford has been with TAI for 16 years and has 11 years’ experience working with electronic medical records systems, practice-management systems, and other health care information technologies. He also manages a physical-therapy network in the states of Oregon and Washington, and owns CareConnections, a Web-based suite of rehabilitation quality and utilization management tools. For more infor-mation, visit www.therapeuticassociates.com or www.careconnections.com