Intracare Implementation Log Episode 14: Hardware, multi-user systems?

[Ignacio Valdes]

Has anyone done multi-user, one computer CPRS oriented Windows
workstations? If so, can you share your experience? We probably need
about 30 workstations running from probably 12 PC's. An ideal solution
would be to run 4-6 stations from one PC. Has anyone done this
recently? In principle this should be possible with USB hubs, USB
keyboards and mice and additional PCI video cards. There are multiple
examples of doing this using Linux for desktop (see below) but there
does not appear to be as much for Windows (see below) and doesn't
appear to have much for what we will probably end up using for the
client due to local conditions. Our WorldVistA server is Fedora 9
based.

Linux:
http://linuxgazette.net/124/smith.html [linuxgazette.net]
http://www.google.com/search?q=multiseat+x [google.com]
http://cs.senecac.on.ca/~ctyler/ruby/ [senecac.on.ca]
http://blog.chris.tylers.info/index.php?/archives/
14-Multiseat-X-Under-X11R6.97.0.html [tylers.info]
http://www.linuxtoday.com/infrastructure/200512070 0126OSDTHL [linuxtoday.com]
http://www2.userful.com/

Windows:
http://www.ncomputing.com/
http://www.elecomsystems.com

[Vipen Mahajan]

I have run Tin Clients of a dual-core 1.8 ghz, running WindowsXP. For a chec out. It was able to run the Windows applications using the X{ server. I guess it should be able to run 3-4 Thin Clients, from observing the CPU loads. The bandwidth needed from te server to a CPRS client is about 30-50 kbits/sec.

--
Vipen Mahajan

Skype ID - vmahajan
VOIP USA +1-630-303-9881

Rabindranath Tagore:
Where the mind is without fear and the head is held high
Where knowledge is free
Where the world has not been broken up into fragments
By narrow domestic walls
Where words come out from the depth of truth
Where tireless striving stretches its arms towards perfection
Where the clear stream of reason has not lost its way
Into the dreary desert sand of dead habit
Where the mind is led forward by thee
Into ever-widening thought and action
Into that heaven of freedom, my Father, let my country awake.

[I, Valdes]

Have you been able to do multi-user like several users working on one
computer with multiple keyboards and displays vs. multiple thin
clients?

-- IV

On Sep 18, 1:27 pm, "Vipen Mahajan" <vmahaj...@gmail.com> wrote:
> I have run Tin Clients of a dual-core 1.8 ghz, running WindowsXP. For a chec
> out. It was able to run the Windows applications using the X{ server. I
> guess it should be able to run 3-4 Thin Clients, from observing the CPU
> loads. The bandwidth needed from te server to a CPRS client is about 30-50
> kbits/sec.
>
>
>
> On Thu, Sep 18, 2008 at 10:41 PM, Ignacio Valdes <ival...@hal-pc.org> wrote:
>
> > Has anyone done multi-user, one computer CPRS oriented Windows
> > workstations? If so, can you share your experience? We probably need
> > about 30 workstations running from probably 12 PC's. An ideal solution
> > would be to run 4-6 stations from one PC. Has anyone done this
> > recently? In principle this should be possible with USB hubs, USB
> > keyboards and mice and additional PCI video cards. There are multiple
> > examples of doing this using Linux for desktop (see below) but there
> > does not appear to be as much for Windows (see below) and doesn't
> > appear to have much for what we will probably end up using for the
> > client due to local conditions. Our WorldVistA server is Fedora 9
> > based.
>
> > Linux:
> >http://linuxgazette.net/124/smith.html[linuxgazette.net]
> >http://www.google.com/search?q=multiseat+x[google.com]

> >http://cs.senecac.on.ca/~ctyler/ruby/<http://cs.senecac.on.ca/%7Ectyler/ruby/>[
> > senecac.on.ca]
> >http://blog.chris.tylers.info/index.php?/archives/
> > 14-Multiseat-X-Under-X11R6.97.0.html<http://blog.chris.tylers.info/index.php?/archives/14-Multiseat-X-Unde...>[
> > tylers.info]
> >http://www.linuxtoday.com/infrastructure/2005120700126OSDTHL [

[Vipen Mahajan]

No, I did not try that. But u would be limited as the multi users would probably be connected over an USB cable, so max of 15 ft. I think.

[I, Valdes]

That's okay, we are wanting to use a 'cluster' approach as that will
work best with our physical plant. For example 2 nurses on two heads
at 1 nursing station, a table with 4 clinicians, 4 heads and 1 machine
serving the 4. -- IV

> > > >http://linuxgazette.net/124/smith.html[linuxgazette.net]<http://linuxgazette.net/124/smith.html%5Blinuxgazette.net%5D>
> > > >http://www.google.com/search?q=multiseat+x[google.com]<http://www.google.com/search?q=multiseat+x%5Bgoogle.com%5D>
> > > >http://cs.senecac.on.ca/~ctyler/ruby/<http://cs.senecac.on.ca/%7Ectyler/ruby/>

[Ben Mehling]

On Thu, Sep 18, 2008 at 12:43 PM, I, Valdes <iva...@hal-pc.org> wrote:

That's okay, we are wanting to use a 'cluster' approach as that will
work best with our physical plant. For example 2 nurses on two heads
at 1 nursing station, a table with 4 clinicians, 4 heads and 1 machine
serving the 4. -- IV

Igancio-

This is an interesting idea.  Is Windows a requirement -- are there other windows-based applications your staff must run at the nursing station as well?

- Ben

[Nancy Anthracite]

I think some people have a Windows server and use remote desktop sessions from
their Linux machines or Windows macine to run CPRS Windows machine. I think
they find it is easier to maintain and faster.

--
Nancy Anthracite

[Vipen Mahajan]

I had researched this many months back, but I remember that a vendor, probably useful.com, has some interesting configurations where the single server can power 5-10 "Thin Clients".

[Vipen Mahajan]

Sorry it was userful.com

[I, Valdes]

Sounds good. The reason we want to do multi-user from one machine is
cost. Psychiatric hospitals are very squeezed by managed care and can
afford practically nothing so we need to go as rock-bottom as we can.
1 CPU per 4-6 clinician seems like the least expensive/easiest to
manage and fits our layout well versus 4-6 thin client boxes taking up
space in the charting areas. Is that anyone else's experience?

-- IV

On Sep 18, 2:06 pm, Nancy Anthracite <nanthrac...@verizon.net> wrote:
> I think some people have a Windows server and use remote desktop sessions from

> their Linux machines or Windows machine to run CPRS Windows machine. I think

[I, Valdes]

How are things with CPRS on Linux using Wine? Any real world
deployments? -- IV

On Sep 18, 2:06 pm, Nancy Anthracite <nanthrac...@verizon.net> wrote:

[Vipen Mahajan]

Let me know if u have difficulty in finding these guys, I will try and dig up thr ifo.
Vipen

[I, Valdes]

Nothing real specific that OpenOffice cannot handle. The IT staff is
actually pretty happy that all this is NOT browser based because
spyware and trojans are a constant problem. Clinicians have nothing
right now so there is no applications to displace.

-- IV

On Sep 18, 2:48 pm, "Ben Mehling" <ben.mehl...@medsphere.com> wrote:
> On Thu, Sep 18, 2008 at 12:43 PM, I, Valdes <ival...@hal-pc.org> wrote:
>
> Ignacio-

[Ben Mehling]

On Thu, Sep 18, 2008 at 1:58 PM, I, Valdes <iva...@hal-pc.org> wrote:

Nothing real specific that OpenOffice cannot handle. The IT staff is
actually pretty happy that all this is NOT browser based because
spyware and trojans are a constant problem. Clinicians have nothing
right now so there is no applications to displace.

That being the case, then a multi-head Linux box is a real option for your site.  

I really like this idea for a busy nursing station.  In this model, only one workstation, network connection, etc. is required.  There is up-front cost and long-term power savings.  It's a green solution too.

As a facility transitions to full electronic clinical documentation and CPOE, we definitely need to make certain providers aren't being forced to queue up due to a limited number of workstations.  Not only does this slow down the workflow of the facility, it lowers provider adoption rates as "waiting for a workstation" just becomes just another frustration (there's enough already!) of the transition to an EMR.

The Userful.com solution looks pretty well packaged, but I'm sure rolling your own is do-able as well.

- Ben

[Nancy Anthracite]

We are awaiting CPRS 27 Delivery to get the Codeweavers seriously working on
this because 27 is built on Delphi 2006 instead or Delphi 6 or 7. There are
no deployments to my knowledge because all of it does not work on Wine.

--
Nancy Anthracite

[Jim Self]

I, Valdes wrote:

The IT staff is
actually pretty happy that all this is NOT browser based because
spyware and trojans are a constant problem. Clinicians have nothing
right now so there is no applications to displace.
  

If spyware and trojans are problems, that is more a function of your choice operating system and browser and your network management policies. Web based applications don't have to be open to the internet any more than other networked applications.

-- 

---------------------------------------
Jim Self
Systems Architect, Lead Developer
VMTH Information Technology Services, UC Davis
(http://www.vmth.ucdavis.edu/us/jaself)
---------------------------------------
M2Web Demonstration with VistA
(http://vista.vmth.ucdavis.edu/)
---------------------------------------

[Fernando]

Hi, nice to meet you all.

Just a thought, why not just use a Linux based (flash) thin client ? It
´s cheaper ($200-300 per seat) than hub solutions and its size is not
that significant (you could use it as monitor support :)). And if the
box crashes just one user gets waiting...

As I´ve said it´s just a thought, in real life I could never escape
from Citrix, as RDP alone doesn´t do the job on larger user bases.

Fernando

On 18 set, 19:53, "Ben Mehling" <ben.mehl...@medsphere.com> wrote:

[kdt...@gmail.com]

Are you going to be using spare workstations? Or are you going to be
buying new hardware? If purchasing new equipment, I wonder if you
could purchase a batch of used computers. I know that our hospital
periodically replaces all their computers, and they have stacks of
them stored until they can find somewhere for all the units to go. I
would think that old hardware would be fast enough to run CPRS (as
long as the OS doesn't have too much eye candy.)

Kevin

[I, Valdes]

Buying a set of used machines at auction or whatever is a possibility
but has its pluses and minuses. Right now I'm favoring a multi-headed
approach but that could change at any moment ;-) Right now the biggest
cost factor is going to be flat-panel displays. They do have to be
flat panel and the least expensive I could find is about $130 for a 17
inch. If you are going to buy 20-30 of these it becomes the largest
cost.

-- IV

[I, Valdes]

Do you have a specific machine in mind that you can send a link too?
-- IV

[I, Valdes]

Any estimate of when or is this a it arrives when it arrives type
thing? -- IV

[Joseph Dal Molin]

It's when of those AWA's

> .
>

[Fernando]

Best of breed (IMO): http://www.wyse.com/products/hardware/thinclients/index.asp
Cheaper alternative: http://www.norhtec.com/products/mcjr/index.html

Fernando

> > > - Ben- Ocultar texto entre aspas -
>
> - Mostrar texto entre aspas -

[Nancy Anthracite]

It has been released in the VA. I have a FOIA request in to get it for all of
us sooner than the ftp site release. My luck with FOIA requests has not been
great.

After that it is hard to estimate how long it will take the Codeweavers to get
it working. They would have to assess it to give us an estimate. We will
also need some detailed descriptions of what is not working, so we have some
work to do there before they even look at it.

--
Nancy Anthracite

[I, Valdes]

They look cool, but they are still pricey, especially when you can
build your own full system (without the form factor advantage of
course) for $155 or less: http://blogs.zdnet.com/hardware/?p=2625&tag=nl.e539

-- IV

[JohnLeo Zimmer]

Nancy Anthracite wrote:

> After that it is hard to estimate how long it will take the Codeweavers to get
> it working. They would have to assess it to give us an estimate. We will
> also need some detailed descriptions of what is not working, so we have some
> work to do there before they even look at it.

Is there a list somewhere of what does not yet work in CPRS 26?

jlz

[David Whitten]

Probably that list exists, but I trust your judgement John,
you have a good eye for discrepancies and a good idea what the
system is supposed to do.

Could you create such a list and put it on VistApedia ?

Dave

[JohnLeo Zimmer]

David Whitten wrote:
> Probably that list exists, but I trust your judgement John,
> you have a good eye for discrepancies and a good idea what the
> system is supposed to do.
>
> Could you create such a list and put it on VistApedia ?

Ok, David,
I added a page to VistApedia for such a list (with no content yet).

http://vistapedia.net/index.php?title=CPRS_Installation#Wine/Crossover

Your trust in my judgement is the only discrepancy I can identify. (I have no
experience with CPRS on Wine.) But I just downloaded Crossover to make an attempt.

I would very much appreciate details from whomever about where the problems
currently exist. Edit the wiki yourself or leave word here, please.

jlz

[Fernando]

Yes, that´s really a great choice, I don´t think I could get those
prices here :(

> > > - Mostrar texto entre aspas -- Ocultar texto entre aspas -

[Jeremy Coleman]

One option that may be slightly more, but has other advantages is
clear cube. http://clearcube.com They say that you can put up to 5 to
6 iports on 1 blade, but if all you are doing is CPRS then I wonder if
you could do 10 or more with degradation. Other benefits are that
physical security is much better, because the pc is a blade that sits
in the data center. The only equipment that would sit at desktop is
the iport and monitor. Also if you get 1 extra blade as a spare you
can have instant failover.

One thing to think about with a multihead pc option, when 1 pc goes
down, the whole nursing station goes down. That make a single pc
failure at 9:30 PM on Friday an emergency. I totally get cranking
down the money on the hardware, but you get what you pay for. Money
spent on good hardware is money saved on tech time working on junk.

[I, Valdes]

When was the last attempt for CPRS on WINE? -- IV

[JohnLeo Zimmer]

I, Valdes wrote:
> When was the last attempt for CPRS on WINE? -- IV
>

last night. :-)

jlz

(I do not have any real information about any of the previous attempts, nor of
any documentation of what was found.)

[Joseph Dal Molin]

....was that a Chardonnay or a Pinot

> .
>

[JohnLeo Zimmer]

Joseph Dal Molin wrote:
> ....was that a Chardonnay or a Pinot

funny you should ask...

"CrossOver Linux Standard includes support for multiple bottles. A bottle is a
virtual Windows environment with its own isolated C: drive, fonts, registry, and
software."

It has been a good while since I've tried Crossover. But now they do store their
"wine" in "bottles"

...cute

jlz

[Woodhouse Gregory]

On Sep 22, 2008, at 6:19 PM, JohnLeo Zimmer wrote:

It has been a good while since I've tried Crossover. But now they do store their 

"wine" in "bottles"

...cute

Do they have corks?

[Nancy Anthracite]

I just tried the latest, 1.1.5 .

--
Nancy Anthracite

[JohnLeo Zimmer]

Nancy Anthracite wrote:
> I just tried the latest, 1.1.5 .

Nancy, do we have any checklist of what works and what fails?

johnleoz

(I was speaking of Crossover 7.0.2)

[I, Valdes]

I'm nearly ready to deploy onto the units here at Intracare. Hardware
is holding me back right now and a GNULinux/CPRS combination would be
ideal and could be quickly deployed. There seems to be little
information as to what are the problems with this lash-up. Does anyone
have further information? -- IV

[Crawford Rainwater]

Another request for the current state of WINE + CPRS as well.

--- Crawford

[JohnLeo Zimmer]

Ignatio, I think it is known that Wine/Crossover is not ready for deployment in
production. However, that is hearsay and lacks any documentation of where the
problems still occur. (I am not saying problems don't exist, just that I don't
have access to any details.)

If a serious attempt to move forward is to be made, these need go be firmed up.
I think we are just going to have to build a list of known (or even alleged)
glitches that we can publish and then test. I put up a page on the wiki for that
purpose. It is empty so far, but it could provide a starting place for those who
want to test CPRS on either wine or Crossover.

Possibly the other GUI tools that are available should be included as they may
provide clues to the remaining problems and potential solutions.

jlz

[Nancy Anthracite]

Sorry. I should have said something. I talked with Ignacio. We are awaiting
the CPRS 27 before the Codeweavers get back to work on this. I recommended
that Ignacio give up on trying to run it on Wine for now. A lot of it works,
but not all of it. We were going to spend the time to find everywhere it did
not work, but decided that that time would better be spent on 27 when it was
release, not on 26 that is about to be replaced.

--
Nancy Anthracite

[Nancy Anthracite]

I have been talking with the Codeweavers fairly recently, and I have the
Crossover version they have that is supposed to be the best for CPRS, and it,
at first glance, is no better than Wine itself at this point.

I REALLY do want to see this happen, but when the Codeweavers are so busy with
paid work and the new CPRS coming out, I think we need to wait rather than
burn up the good will we have with them working on a version that is going to
be gone in a few months.

Now if somebody has really deep pockets and can pay to get this done, that
would change the equation considerably. That is probably going to be a
considerable chunk of change, though - probably $40,000 plus. But even if
Santa Claus showed up, why spend it now on version 26?

--
Nancy Anthracite

[ival...@gmail.com]

We are still experimenting with multi-seat systems without conclusion
yet. What we are planning is 30 permanent workstations over 3 floors
for those that do not have, do not want, or forget or have a broken
laptop. However, we will very likely have wireless and laptops as
well. Can anyone share their policies on that?

Scenarios:

1) Employees, doctors buy or use their own wireless laptop and bring
it in.
2) Institutional laptops per floor that stay in the hospital at all
times.
3) A mix of 1 and 2.

Pros with 1) have own personal machine. Don't have to compete to get
to the institutional ones if there are not enough. Don't have to deal
with things others have done. Cons with 1) security, malware, spyware,
breakage, non-standard configurations, pretty much stuck with Windows.

Pros with 2) Can use Linux. Standard configuration, more secure, never
leaves the hospital. Cons with 2) theft, breakage, competition to get
it, isn't personal.

Pros with 3) The best of 1 and 2. Cons with 3: the worst of 1 and 2.

Thoughts?

-- IV

[Wolfgang Giere]

Mumps Users' Group Germany (MUG-D) was alarmed by a member that Microsoft
planned to include a new programming language "M" in "Visual Studio 2010".
The link to the German message is http://www.golem.de/0810/62894.html

German:"Microsoft arbeitet an neuer Programmiersprache M
M soll in Visual Studio 2010 enthalten sein"

Question to the experts: Is "M" or "M-Technology" copyrighted or trademarked?
Should a MUG (which one?) take actions? Or should we just joke ...

Wolfgang Giere

[Nancy Anthracite]

Did the article say that they were aware of the REAL M?

--
Nancy Anthracite

[Wolfgang Giere]

Am Samstag, 18. Oktober 2008 19:41 schrieb Nancy Anthracite:
> Did the article say that they were aware of the REAL M?

No, not at all.

Wolfgang

[Ben Mehling]

First "Vista" and now "M" -- they want it all! :-)

- Ben

[Steven McPhelan]

Does any legal entity still exist that owns the copyright (if it exists) to M or M Technology?

[Fernando Telesca]

Here´s another link:

http://thecoffeedesk.com/news/index.php/archives/74

Fernando

On 18 out, 19:10, "Steven McPhelan" <smcphe...@alumni.uci.edu> wrote:
> Does any legal entity still exist that owns the copyright (if it exists) to
> M or M Technology?
>

> On Sat, Oct 18, 2008 at 4:25 PM, Wolfgang Giere <W.Gi...@t-online.de> wrote:
>
> > Am Samstag, 18. Oktober 2008 19:41 schrieb Nancy Anthracite:
> > > Did the article say that they were aware of the REAL M?
>
> > No, not at all.
>
> > Wolfgang
>

> --
> Steve
> "People who are brutally honest get more satisfaction out of the brutality
> than out of the honesty." -- Peter F. Drucker

[Brian Lord]

I know we all refer to MUMPS as M because it was an attempt to make MUMPS more proper sounding. However was any work ever done to copywrite M at all? I think the Microsoft folks have probably done their homework and recognize they are stepping on toes, but also probably know there is no legal wall to them using this name.

However with GT.M and Cache clearly not using the name, it seems that is just a legacy name (like DSM, MSM, GreyStone, etc.) that will go the way of history.

It also sounds like Microsoft M will be nothing more than a way to force users to use MS SQL.

Anyway this is probably a fight that unless someone has a legal document, or unless WorldVistA officially protests in the Media will be a losing battle.

[r...@rcresearch.us]

We should bring this to the attention of NEMUG. They are the inheritors
of the legal assets of the MTA. MS would probably hope we would not
protest.