Practice Review: Gundagai Medical Centre
In each edition of Pulse IT, we’ll take a look at a medical practice with an innovative or unique IT setup. We begin our tour at the Gundagai Medical Centre in rural NSW.
Gundagai is a pleasant rural town four hours from Sydney on the Hume Highway, and less than two hours from Canberra. The building that houses the medical centre in Gundagai started life as the town’s emporium, later housed a furniture shop and was reborn after extensive renovations as the town’s medical centre.
The practice was established in 1982 and moved to the new premises in 2000. Opened by the then Health Minister Michael Wooldridge, the council owned building has five consultation rooms, a treatment room, procedures room, resource centre and meeting room, staff facilities and kitchen, and a pathology collection centre. The practice was designed from the ground up as a teaching centre for both medical students and GP Registrars.
The practice is owned by husband and wife team Dr Paul Mara and Dr Virginia Wrice. Visiting specialists include a paediatrician and a cardiologist, and the practice is frequented by various allied health professionals including a podiatrist, physiotherapist, optometrist, psychologist and a diabetic educator.
Dr Mara, who completed a paper on Computer Science during his residence years in New Zealand has always had a keen interest in technology. His first computer purchase, a $12,500 IBM 286 portable was used primarily for word processing and writing computer programs. ‘Portable’ was a term used loosely in the early 80’s, and this machine was literally the size of a suitcase despite having a tiny orange and black screen, and no hard drive!
By the late 80s, Dr Mara had discovered the Mac platform and was drawn to them around the time when Microsoft started releasing the underwhelming early versions of Windows. The slick graphical user interface, user friendly operating system and integrated networking justified the additional expense for Dr Mara.
While this limited his choice of clinical applications, he recalls that the package he was using at the time from Jam Software was vastly superior to anything available on the relatively infant Windows operating system.
When the practice relocated to the new premises in 2000, the practice changed to Genie, and runs the latest version presently.
The practice has a history of innovation. To get broadband Internet to the new practice (which wasn’t available in the town at the time), Dr Mara took extreme measures and established an Internet Service Provider (ISP). As well as providing a much needed local access number for the town (at the time, most rural Internet users needed to pay STD rates to connect to their ISP), he was able to provide affordable Internet access to the surgery.
The move to the new building saw an entire refresh of the practice computers. Since then, the practice has upgraded their systems in waves to ensure hardware is standardised across the practice.
The Genie installation is served by a Dual G4 Power Mac running MacOS X 10.3. This machine is completely dedicated to the task and typically has no direct human interaction. A pair of high performance hard drives are configured in a mirrored RAID arrangement for redundancy. At the time of writing, the machine recorded an uptime of 260 days, testament to the stability of MacOS X, Genie and the highly recommended measure of not using the practice server as a workstation.
The reception area, administration and consultation rooms are serviced by a fleet of eMacs also running MacOS X 10.3. Dr Mara said that while these machines have been reliable, they were starting to show their age. He indicated that he planned to refresh the whole line-up of desktop machines with Intel Macs once Genie releases an Intel native version.
Begrudgingly it would seem, a Dell PC was purchased to facilitate HIC Online which wasn’t available on Macs at the time (although it has been for some time now). This remains in commission to support two Windows-only pathology programs. It also allows for remote access connections using Microsoft’s Remote Desktop Connection program, a technology for which there is no decent Mac equivalent at the host end.
Dr Mara uses a late model G4 PowerBook for most of his computing, but also touts an ASUS laptop to run a few Windows-only applications. While he has tried emulation using Virtual PC, he described this experience as “painful”.
Dr Mara had recently ordered a new MacBook Pro to replace both of his aforementioned laptops.
Each of the consultation rooms has a Kyocera FS-1010. These printers are configured with 3 paper trays (2 cassettes and a multipurpose tray), which minimises manual paper handling.
While these printers don’t have top speeds that compare to current model laser printers, the time it takes for the first page to finish is still competitive and they have been very cost effective to run.
The reception and back office administration computers are serviced by a reliable HP 4050 with 3 paper trays.
2 years ago, a high capacity document scanner was hired to archive to PDF, the 20 years worth of medical records the practice had accumulated. The hire of this device cost around $900, and the task consumed one month of a junior staff members time.
The PDFs were linked to the electronic clinical records using Genie’s Image Pro module. A single click from the patient’s clinical screen opens this PDF, allowing the virtual paper file to be retrieved instantly.
A Brother Multifunction Centre (MFC) was purchased for ongoing scanning and has performed well. Recently this device was superseded by a medium capacity document scanner, however the MFC is still used for scanning pages from bound documents.
Backup and Redundancy
A rack mounted Uninterruptible Power Supply (UPS) provides around 30 minutes of extra uptime to the main practice server and the networking equipment.
The aforementioned RAID mirror installed on the server is designed to provide data protection in the event of a physical drive failure.
A backup program called Retrospect consolidates important files from the various servers that Dr Mara runs. These backup files are transferred to a portable hard drive each night and taken offsite. Around 12GB of data are backed up each day onto the portable device, allowing for around 20 days of “roll back”.
Each Saturday morning, a series of DVDs are burnt and stored securely offsite to ensure a permanent record is kept.
Like many rural GPs, Dr Mara has supported his IT system with little outside assistance. While Divisional IT support has not been in tune with his preferred platform or practice software, he has required little outside assistance citing few hardware problems and commendable software support from Genie.
Good, Bad, Ugly
Having highlighted most of the following himself, Dr Mara demonstrated an excellent grasp of the strengths and shortcomings of his IT system:
- Standardised hardware purchasing makes software control easy and spare parts readily available when the computers begin to fail.
- The predominantly Mac system should continue to provide a stable, easily maintainable platform into the future.
- The absence of pathology and radiology software on the server is a highly recommended measure.
- Preventative data protection measures have been taken i.e. UPS and RAID.
- Ideally, the proprietary backup solution should be replaced with a system that allows the files to be restored without the use of the software. The Unix utilities built into MacOS X should be exploited to create backups that will ensure easy restoration for years to come.
- On the release of an Intel Mac native version of Genie, the client computers should be replaced to improve the performance for the users.
- When these new client computers are purchased, a new network switch should be installed to take advantage of their gigabit network cards.
- While the high server uptime is impressive, it indicates that the operating system hasn’t had recent security patched installed. These should be downloaded and applied ASAP.
Posted in Australian eHealth