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Cutting out Windows and fat clients, part 2

The IT staff at CT NeuroCare was able to cut costs and increase productivity by switching to a thin client and open computing model. This is their story.

Ron Nath and Bryan Tidd are no sheep. The two IT managers decided to take their off organizations off the well travelled proprietary road in favor of an open computing and thin client approach. And both were very pleased with the results.

In part two of this case study, Nath, IT manager for CT NeuroCare in Wallingford, Conn., explains how taking a thin client approach helped the medical center cut significant costs and avoid vendor lock-in. In part one, Tidd told the story of how cutting the fat (clients) meant significant productivity gains for the City of Canton, GA.

Locked in, and not liking it

When setting up the IT system for CT NeuroCare in Wallingford Conn., Nath, the medical center's IT manager, initially took a proprietary route consisting of the Windows XP operating system and ChartWare EMR electronic medical records application.

"I used these because that's what others suggested," he said. "I made the mistake of not researching myself."

Within a few months, Nath, who was feeling the effects of vendor lock-in first hand, became disenchanted with Microsoft. He decided that his organization could save money and increase productivity by using and open source operating system.

"I felt trapped by [Microsoft's] design decisions," he said.

Unfortunately, Nath ran into a roadblock. 

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"I wanted to move to a non-Microsoft environment, but I found that our EMR product was not cross-platform and only worked on Microsoft platforms," he said.

Extensive research followed. Nath quickly settled on the Fedora Core 3 operating system for his single-server operation. Then, he looked at a number of free EMR products, including FreeMED, Gnumed, SQL Clinic, VistA and OpenEMR.

OpenEMR best fit CT NeuroCare's needs, Nath determined. It's a free, open source practice management EMR program for patient scheduling and demographics, as well as for prescription writing and delivery via e-mail or print. Bundled into OpenEMR is phpMyAdmin, a reporting and MySQL administration tool.

Nath thought "outside of the box" in his software choices. Then, he decided that he could get better results by doing more than finding a new platform and application. He chose a new IT architecture altogether, a central server with smart, thin clients.

"I realized the waste of resources and lack of control in the traditional fat-client approach," Nath said. "I realized that we had come full circle by going back to the mainframe approach; but this time with smart terminals instead of dumb terminals."

Nath donated CT NeuroCare's existing desktops to a charity. Then, he bought five NETion thin clients from . NETions are embedded Linux machines with Mozilla browsers. They have the flexibility Nath sought, being capable of running in Linux, Unix, Citrix, Windows Terminal Server and mainframe environments.

Nath runs Linux on his new 64-bit Xeon Dell 2850 server. It has 2GB RAM, 300GB of RAID-5, SCSI disks and dual gigabit NICs (network interface controllers).

The results have been excellent. The simplicity of OpenEMR and the thin clients has improved worker productivity. Nath likes the ease of administration and flexibility.

"This has been untried by anyone I know," he said, pleased that – this time around – he didn't just follow the herd down the proprietary path.

For more information:Read part one of this case study, where Tidd explains how getting rid of fat clients and turning to Linux led to significant productivity gains for the City of Canton, GA.

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