Hardware, Software & Network Configs

[Joe Gordon]

All Power Users- I am interested in your computer/network configs. I know many of you have listed such configs a while ago, and wondering what you have presently:

1. Server Config
2. Operating system(s)
3. Backup config/software
4. Remote access config/software
5. Antivirus software
6. Network (wired and wireless) hardware (ie- routers, switches, access pts, etc)
7. Any slick software you've been using (dropbox,pocket cloud, etc)

I would love to hear your pros on your present configs compared to what you upgraded from. Also any cons on the present setup would be appreciated.
Many Thanks...Joe

[teethdood]

1) Server Config: Desktop 8GB RAM with two-2TB hard drives set up in RAID1 mirror under Ubuntu Linux. Then Virtualbox with Windows Server 2008 running on top of Ubuntu.
Pro: inexpensive, easy backups (just copy the virtualbox image to another computer/USB drive). You can read the other thread postings about server configs.
Con: complicated, must be proficient with windows and linux
2) OS: Server runs Ubuntu with Windows Server 2008 as guest OS, client computers run windows 7 Home. Peer-to-peer mode. If you want to run a domain, you would need to upgrade to windows 7 Pro/Ultimate
3) Backup Config/Software: Snapshot every hour in virtualbox to revert to any moment in time to safeguard against human mistakes. For hardware problems, copy the virtualbox image to other computers/USB drive at the end of the day.
4) Remote Access: TightVNC/built-in Windows Remote Desktop Connection. Can also run VPN
5) Antivirus: Linux server is practically immune to viruses. Windows server running as guest OS runs ESET NOD32. WIndows 7 clients run MS Security Essentials - free
6) Network: Router runs DD-WRT to allow for 2 networks: 1 for actual network, the other for patients to use if they request it. Server wired to router for stability/no interference. Clients are all wireless/less messy. My first office I hard wired all the computers, but the switch and/or router would die once in a while. Wireless = no switch = one less point of failure.
7) slick software: the one and only Open Dental!

[Joe Gordon]

Thanks, Philip. Wow!

[Hersheydmd]

Phillip,
Could you explain how you set up your router for two networks? I'd like to do the same. Is two the limit or can you do three as well? I have a wired configuration with a Netgear router.

[teethdood]

Hi Doc Hershey,

Two websites with relevant information:
http://www.dd-wrt.com/
http://www.polarcloud.com/tomato

I don't advise messing with what's already running, instead you should purchase a DD-WRT/tomato compatible router to play around with. Having said that, your existing netgear router is probably compatible, so hack away. Check with the dd-wrt site. Lots of cheapy Wireless N routers that are compatible to be had. I personally use dd-wrt. Flash your router with the dd-wrt firmware and away you go. You can flash it back to the default netgear firmware later (again, check). The configuration pages can be quite overwhelming but that's by design: to enable you to have complete control over the smallest setting. You can also restrict the speed for the guest network so people can't abuse it with torrents, etc.
Edit: I believe dd-wrt allows for 2 networks only

[Joe Gordon]

Would still love to hear from many more users on your specs. Everyone's configs are sure to be way better than mine, as I haven't upgraded much hardware or software in years. Just looking for advice on how I should ramp mine up. Again, thanks for taking the time.

[Rickliftig]

1. Server Config
-Server is a Dell SC1420 - dual 80GB RAID and 2gb memory running Server 2003 _ I have a duplicate server in my basement at home that I use to backup. It was old but unused when I bought it off of ebay for under $500.
-I have 5 HPDC5100 SFF workstations with Windows XP Pro
-Two tablets - Motion LE 1700 with XP Pro and Itronix GD3000 w/Windows 7 pro

2. Operating system(s)

3. Backup config/software
Logmein Backup to home. Karen's Replicator backs up to another computer in the office four times a day

4. Remote access config/software
Logmein

5. Antivirus software
AVG Business

6. Network (wired and wireless) hardware (ie- routers, switches, access pts, etc)
Switch is a Cisco 20 port managed switch
Also I have a DSL modem which provides the wireless signal - Actiontec
The wiring in the office is CAT6

7. Any slick software you've been using (dropbox,pocket cloud, etc)
I use dropbox all the time - this is how I coordinate programs like one note. Also Google Calendar and Google Voice for after hours calls - With GV, emergency call are transcribed and sent to me as e-mail)



The computers for the most part were lightly used when bought. My entire system cost well under $3000, but then electronics has always been a hobby.

[murmsk]

Now don't laugh but this will show most anything will work.

Server - linux server setup in 2004 runs redhat 2? I can't remember the specs but it was a strong machine 6 years ago. I open the door to make sure the lights are on at least every 6 months . I also have the computer at the front desk setup as a backup server with Mysql shut down. At the top of every hour I do a datadump with mysqladmin to the backup server. Every noon and evening data is also backed up to the backup server via OD. Once a week my receptionist redirects her computer to the backup server to check viability. The data in several forms is encrypted w/ truecrypt sent home via dropbox. With the backup server concept if the main server goes down within 2 or so minutes I am back up and running.

I buy a new computer every year so the op computers are a mixed bag most still run XP 2 run windows 7. The ops are dual screen. The last replaced computer stays as a backup for the rest of the year then gets blanked and donated to a HS student who is in need. I don't notice much difference in performance from one to the other except when taking x-rays. The delay between shots is several seconds longer on the older machines. I also have a tablet HP TC4400. It is not as pretty as an ipad but it works fine. The stylus is some sort of magnetic tip which allows for patients to rest their hands on the screen when signing. I also use it for ortho charting.

All rooms/computers are hard wired except the tablet.

I know I should re-do the server before it dies. It is on the short list of things to do. There is a part of me that would like to see just how long it would last . I am up to 35 gigs of data, pictures so I have HD space for another 5-6 years. I do find the concept of a linux server running virtualbox intriguing.

The point is that OD is so easy on network resources that almost anything will be serviceable
steve

[Joe Gordon]

Many Thanks, Rick & Steve. Very helpful.

[stjames70]

1. Server Config
MacPro 16gb, 4 1tb drives, one external backup drive. MacPro contains main OD database running in a VM using VMWare Fusion 3. All workstations are iMacs running OD using VMWare Fusion 3. Since OD is very small and uses very little resources, this set up is extremely fast. Database backed up daily to Carbonite, to a TimeMachine, and to an external HD. We carry a 'virgin' VM with OD in case the functional VM becomes corrupted or infected. In case our functional VM with the OD database becomes unusable, we just toss it in the trash, boot up the 'virgin' VM with OD and restore the database. It has never happened....
2. Operating system(s)
Mac OSX 10.6.7
3. Backup config/software
Carbonite and Data Backup
4. Remote access config/software
MobileMe Back to My Mac
5. Antivirus software
None -- just slows down the system. Staff not allowed to use Windows VMs to check email or to browse
6. Network (wired and wireless) hardware (ie- routers, switches, access pts, etc)
Cisco Router connected to an Airport Extreme. All computers connected wirelessly 802.11n
7. Any slick software you've been using (dropbox,pocket cloud, etc)
Remote Desktop for Mac allows for easy management of all workstations and monitoring of all operatories using built-in webcams

[packets]

3. Backup config/software
Carbonite and Data Backup

Doesn't HIPAA require the offsite storage or "removable/transportable digital memory medium" of PHI to be encrypted both "in transit" and "at rest"?
Your solution(s) might possibly miss the mark...Just a thought.

[stjames70]

Good point. Do you know any software that will encrypt backup to physical media and any cloud backup services that backup your data enroute? I could google it, but I think you know the answer....

[stjames70]

hmmm,

Never mind, I did not know it, but Carbonite uses a combination of Blowfish and DES encryption while Data Backup uses AES-128 algorithm.
This standard is the latest encryption standard approved by the U.S. Government for sensitive documents. So my current set-up does comply with HIPAA regs.

[teethdood]

Remote Desktop for Mac allows for easy management of all workstations and monitoring of all operatories using built-in webcams

My All-in-One computers in the operatories have built-in webcams also. Is it legal/unethical to monitor via webcam if patients don't know it? I mean if I were to stick a camera overhead where they can see and know what it does, then it's fair warning. But if patients don't know that you are monitoring them in secret, are you treading in hot water here? I'm asking because that sounds like a good idea to me too. Heck, I wouldn't want to be accused of having wandering hands if I have the videos to prove my innocence.

[packets]

Good point. Do you know any software that will encrypt backup to physical media and any cloud backup services that backup your data enroute? I could google it, but I think you know the answer....

Cobian Backup http://www.cobiansoft.com/

[packets]

hmmm,

Never mind, I did not know it, but Carbonite uses a combination of Blowfish and DES encryption while Data Backup uses AES-128 algorithm.
This standard is the latest encryption standard approved by the U.S. Government for sensitive documents. So my current set-up does comply with HIPAA regs.

I believe Carbonite encrypts data "in transit" but this "data" is not encrypted "at rest", it's only then password protected which may not be compliant.

[stjames70]

I use the webcams to communicate with my assistants -- but you are right on as far as patient privacy. I will include that information in my initial patient paperwork and have the patients sign a form with the understanding that there are webcams active at all times for legal reasons.

[stjames70]

OK, I get it as far as encryption. I will use my Data Backup to encrypt my data at rest to a specific backup drive, and then have Carbonite copy that data to their servers. The data is encrypted at rest, reencrypted once more during transfer to the offsite Carbonite servers, and stores offsite in encrypted version. That way the backup is fully encrypted all the way.

[packets]

OK, I get it as far as encryption. I will use my Data Backup to encrypt my data at rest to a specific backup drive, and then have Carbonite copy that data to their servers. The data is encrypted at rest, reencrypted once more during transfer to the offsite Carbonite servers, and stores offsite in encrypted version. That way the backup is fully encrypted all the way.

Very frustrating! The rapid forced move to EMR’s has so many unresolved issues and so few solutions availible addressing the access to and the portability of PHI.
The risk and misinformation with many services and solutions currently deployed, enormous.
HOPE is not a security strategy, unfortunately too many are deploying "it" in big doses!
Technology is empowering and the potential for process efficiencies unrealized, but just about the time you think you've arrived, you discover you're in the wrong place. D'oh!

[teethdood]

Truecrypt

1) You can use it to encrypt your entire drive (downside: not feasible for backup purposes due to big file size, safeguards against someone stealing your server)
or
2) Encrypt just the directories you want (ie OD database, X-rays, etc.) then when you first start the server, you'd enter a password to decrypt to allow your OS access to the files. Then all you'd have to do to backup is copy the truecrypt encrypted folder over to your removable drive/cloud drive etc.
or
3) Do both.

Now, the OD database is small so it's great for cloud backup. If you include the A-Z and X-rays images, it would balloon up pretty quick.

[packets]

Another concern may be if the off-site storage service provider (e.g., Carbonite), due to your use for backup, now become a Business Associate (BA), and must they be HIPAA/HITECH compliant?
Many questions, few answers...

[stjames70]

I just checked out another feature of MacOSX called file vault. It encrypts all the information you put in your 'home' folder (that is where I would put in OD database). Anything that is backed up from that folder would already be in encrypted form. This would remove at least one layer of work.
I will be switching my offsite backup to iCloud since I do run OSX, and I don't know the answer as to whether any offsite backup systems are HIPAA compliant. The data I am backing up will have at least one layer of encryption -- I suppose if someone was really hard up, they could hack into the offsite backup, steal an encrypted file, decrypt that file, and then use the patient data for some nefarious purpose -- boohahaha! I know, not a joking matter, but this amount of regulation, if really enforced to its full extent, is going to bog us down, and force us to raise fees in order to cover these administrative costs

[packets]

I just checked out another feature of MacOSX called file vault. It encrypts all the information you put in your 'home' folder (that is where I would put in OD database). Anything that is backed up from that folder would already be in encrypted form. This would remove at least one layer of work.
I will be switching my offsite backup to iCloud since I do run OSX, and I don't know the answer as to whether any offsite backup systems are HIPAA compliant. The data I am backing up will have at least one layer of encryption -- I suppose if someone was really hard up, they could hack into the offsite backup, steal an encrypted file, decrypt that file, and then use the patient data for some nefarious purpose -- boohahaha! I know, not a joking matter, but this amount of regulation, if really enforced to its full extent, is going to bog us down, and force us to raise fees in order to cover these administrative costs

I would recommend any service provider that touches your protected content regardless of its state (i.e., encrypted) sign a BAA.
If they're HIPAA/HITECH compliant they should provide you with such! If they’re not, should you even consider their solution? It's your risk to weigh...

[stjames70]

Indeed I have thought of the issues you have brought up and my ultimate conclusion: come get me!
If the government has enough resources to go after one dental office out of the thousands of health care facilities in the nation, then I will eat my punishment if they wish to dole it out.
End of story.
This discussion is frankly nonproductive in every sense. I think I will go back to my office and do what I do best: running a dental business.