The LAN set-up that I have is very inexpensive, in fact a fraction of the cost of hardware recommended by many software vendors. The hardware server in particular needs to have a processor with enough power, enough RAM and adequate hard-drive storage to run EMR/PM software that supports 10 or more workers accessing the server at one time. Therefore a more advanced server than the 10-year old unit I use is advisable.

The cost of a refurbished Dell PowerEdge 1850 server with a 3.0GHz Xeon processor, 1GB of RAM and a 36GB 10K rpm harddrive costs $875 from Vibrant Technologies, a refurbisher and reseller of server hardware. That server is adequate - in combination with additional harddrives needed for overall storage and data recovery storage - to run most EMR/PM software for up to 30 or 40 users.

Similarly a Dell PowerEdge 6850 with a Quad processor at 3.16GHz, 8GB of RAM and three 73GB harddrives at 10K rpm is $1,650. This can handle database and applications software for up to 150 users.

In other words, high-capacity equipment is very cheap.

The client machines can be new or used thin clients costing a few hundred dollars each at most or used PCs with the normal external drive and harddrive set-ups that can be obtained for a comparable amount or even less depending on the vintage.

This configuration of software and hardware that I have is appropriate for a physicians office with 5-10 workers.

For the network operating system, I use Fedora 6, a Linux distribution from Red Hat. The machine that the software runs on is an old Intel-processor-based system from around 1999 that has a Pentium III processor.

The system currently has 8 nodes, including the server. One of the nodes runs Windows XP Professional on a low-powered Dell desktop that I was given by a client when the client upgraded its equipment. A second Dell desktop from the same source runs Ubuntu with Gnome as the GUI.

There are two thin client machines that run off of the desktop I use that runs Windows XP Professional. The operating system includes Terminal Services software that permits an unlimited number of users. One thin client unit is from Neoware. The other is from Wyse. The operating system software is Linux for both.

The desktop that provides Terminal Services is my primary workstation. It is an inexpensive E-machines system unit ($500 for the system unit alone) that I bought in 2007. It is a dual-boot machine which also runs Ubuntu Linux with Gnome.

Another node is a Sony Vaio that runs Windows XP Professional.

The final node is a Lenovo ThinkPad tablet that I bought in 2007. The tablet was originally equipped with Windows Vista, but I removed that and installed Windows XP Professional and Ubuntu Linux with Gnome as a dual-boot machine. It is the latest and greatest as of mid-2007 and was correspondingly expensive, about $2,000, but it is an outstanding machine.

The Internet connection is provided by Comcast via a cable line at an adequate upload and download speed. The router is an inexpensive Linksys brand. There is another router that handles the SIP signals for VoIP phone service. One of the phone ports is connected to the internal phone wiring, so ordinary phones are used. I will install Asterisk shortly, which is an integrated software PBX system, but at the moment I do not have an overwhelming need for it.

Various machines are connected physically to the LAN with inexpensive Linksys 4-port and 8-port switches. The router broadcasts a radio signal for wireless devices, such as the tablet. The ESSID (Extended Service Set Identification that identifies the access point) is encrypted with WPA2 (Wi-Fi Protected Access 2).

Aside from the use of the Windows XP Professional machine as the server for the thin clients, the main server hardware unit is equipped with most of the normally implemented software services, including Apache for serving several hosted websites among other files, Tomcat and JBoss application servers, MySQL, a range of programming compilers/interpreters for C, Java, Perl, PHP and other languages. The server has a Postfix/Dovecot e-mail server set-up and runs Samba to interconnect the Windows and Linux machines. The Apache server also handles XML-RPC, UDDI, WSDL and SOAP requests, the latter three using Axis.

There is a version of the FOSS OpenEMR EMR/PM system on the server and a version of the VA's OpenVistA system. The dual-boot desktop and dual-boot tablet both have the CPRS GUI for interacting with the VistA system on the server.

All in all given the fact that I am using second-hand equipment and mostly FOSS software, the entire configuration, aside from the tablet which I purchased for specific applications requiring the touchscreen and easy physical portability, the cost of all software and hardware is probably $1,000 or so (that is because of sunk costs and free equipment, although purchasing everyting used is only marginal more expensive). This includes all monitors which are cathode-ray style (one is a flatscreen LCD which cost at the time about $200, now probably $100) and cost about $50 each.

This kind of set-up is adequate for any physician's office with a similar number of nodes. A faster server makes sense, as noted above. This however is likely to be quite inexpensive if bought used. The only significant expense would be wireless tablets that generally should be bought because of their portability. Mine is a Lenovo ThinkPad X61. I am partial to ThinkPads, but there is a good range of similar units available from the normal vendors.

I will add a schematic of the LAN setup, including details on the equipment and the approximate costs of the components, shortly.

Schematic not ready, but interim specifications on the components of the LAN here.