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Powering up: tips for buying a computer that will last

You may be tempted to buy a slower machine, but experts say that it will cost you in the long run

From the May 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.

By Howard Wolinsky

For years, Jerome H. Carter, FACP, has advised physicians interested in purchasing a computer to avoid buying processing power that they don't need right now. As hardware prices continue to plummet and computer chips get faster, however, he is changing that advice.

As anyone familiar with the computer market knows, buying a computer presents a unique dilemma: Do you purchase a low-cost machine that will serve you well now but may quickly become obsolete, or do you buy as much power--and spend as much money--as possible to stave off obsolescence for as long as possible?

Dr. Carter, an assistant professor of health informatics and medicine at the University of Alabama School of Medicine at Birmingham who regularly talks about medical computing at Annual Session, said he is increasingly advising physicians to plan for the future when buying a computer. With most software consuming more processing power and memory, he said, he finds it difficult to make a strong argument to buy less, not more, power.

As an example of why more power is essential, Dr. Carter pointed to the Internet. He said that with the explosion of medical material available on the Internet, physicians will need faster processors, more memory and faster modems to make the most of the time they spend surfing the Internet, searching Medline or downloading audio and video files.

How much speed?

Even if you don't plan to take advantage of some of the Internet's more cutting-edge features, you may still need a faster computer than you think. Because software is being designed to take advantage of advancements in processor speed, going with less speed may make your computer prematurely obsolete.

The power of a computer is determined in part by the speed of its processor, which is rated in megahertz. While 233 megahertz or 266 megahertz machines may be attractive because they are being offered at bargain prices, Dr. Carter suggested that physicians consider buying a machine with a 450 megahertz processor.

The difference between a lightning-fast system and a slower but cheaper one is often not enough to justify the cost difference. "There's no reason to buy a 300 megahertz machine when you can go out and buy a 450 megahertz machine for just $300 more," he said.

Sarah T. Corley, FACP, a general internist in Washington, D.C., recently replaced the five-year-old system she and her partner had been using with the latest technology. The practice spent about $30,000 to buy 12 desktop computers with 450 megahertz Pentium III chips, the fastest processors that were available when she made the purchase, and one server to link them.

Dr. Corley, who is also an associate professor at George Washington University, said that the goal was to give all staff members in the practice, including nurses, their own workstation and to boost overall productivity. Because the practice bought such high-end machines, it was able to install Windows NT, which is a much faster and more stable operating system.

Getting a turbocharged system was also necessary to reach the practice's long-term goal of moving toward a paperless office. Physicians enter patient histories directly into the computer using a voice-dictation system. Phone messages, prescription refills, patient advice and lab results are handled through the electronic medical record software. Physicians and nurses no longer pull charts to handle patient phone calls.

Despite such advantages of high-power computers, some physicians have found 233 megahertz processors too good a bargain to pass up. William A. Harrison, ACP-ASIM Member, a general internist in Cheyenne, Wyo., who is part of a group that includes two pediatricians and one physicians assistant, bought four new computers last summer from Compaq Computer Corp. as part of a special program for medical practices. Each computer, including a 233 megahertz processor and monitor, cost less than $1,000.

While experts would argue that a 233 megahertz machine is already close to being outdated, Dr. Harrison said that the technology is more than adequate for his small group. "Because we are not dealing with huge graphics files, 233 megahertz is plenty fast," he said.

Although Dr. Harrison acknowledged that his group's new computers are not exactly state-of-the-art, he was quick to point out that they have already helped his practice operate more efficiently. The physicians use electronic charting software and have begun purchasing medical textbooks on CD-ROM.

So which speed processor is right for you? Experts say that the difference between the systems that Drs. Harrison and Corley purchased illustrates one of the most important principles in purchasing a computer: Decide how you want to use the system, including what software you will run, and then choose the hardware. "You always pick the software first," Dr. Carter said. "Assuming you have a specific software package you want to run, the first thing is to find the hardware you need to run that particular package."

Dr. Carter, who is still using an older 233 megahertz machine with 80 megabytes of RAM and a 2 gigabyte hard drive, said that he personally thinks that most physicians need a system somewhere between Dr. Harrison's and Dr. Corley's. But in terms of keeping up with new technology, he said the choice is clear: "Two years from now, which computer will be most capable of keeping up?" he asked. "Will it be the 233 machine or the 450 machine?"

Memory and other considerations

While processor speed is typically touted as the most important element in a computer's performance, other factors can be just as critical. Here are some considerations:

RAM. Random access memory (RAM) is the working memory that allows your computer to run software. Experts say that even an extremely fast processor can be quickly crippled by too little RAM, so buyers should avoid skimping when it comes to memory.

Dr. Carter suggested purchasing at least 32 megabytes of RAM but said that 64 megabytes or more will give your machine optimal performance. "The more applications that you run at the same time, the more RAM you need," he said. "It really comes down to how much work you are doing."

Because her practice needs to run a number of applications concurrently, Dr. Corley had 64 megabytes of RAM installed in her system. She explained that having so much memory allows her to run the electronic medical records software fast enough so it does not slow down physicians or nurses.

Dr. Harrison, on the other hand, purchased machines with only 16 megabytes of RAM. He said that while his practice has had no problems with what most experts consider an anemic amount of memory, he is considering adding RAM, primarily because it would be worth the investment.

Hard disk. Another factor is hard disk space. A computer's hard disk, also referred to as its hard drive, is where software and all files are stored. Disk space is rated in megabytes and gigabytes (100 megabytes).

Just as software eats up processor speed, it consumes huge amounts of hard disk space. Dr. Carter noted that Microsoft Office alone can take up more than 100 megabytes of hard disk space, which is why he recommends no less than 4 to 6 gigabytes of memory for a machine that will be used in a practice. (He noted that 2 to 3 gigabytes is adequate for typical home users.)

In Dr. Corley's practice, the individual workstations each have 6 gigabytes of storage space, while the server has 9 gigabytes. "New software always takes up more space then you think it will," she said. "The prices are low enough that that more memory can be had for a reasonable price."

Dr. Harrison's practice bought machines with 2 gigabytes of hard disk space. Again, he said the practice has encountered no problems, primarily because it is using software that works mainly with text.

Modems. With the Internet becoming an increasingly important source of information, modem speed is another critical consideration. Modems are typically rated in kilobits per seconds (kps); Dr. Carter said that a 56 kps modem is adequate for most uses.

Monitors. According to Dr. Carter, a 15-inch monitor is adequate for business applications as long as you don't mind having to shut one screen to view another. But if you plan to do multiple tasks at once, like using the Internet and copying text into word processing software, he said, you might want to consider buying a 17-inch monitor.

"Often, I am on the Internet and I have my Microsoft Word processor open, and I am looking for things on the Internet, and I am cutting them from the Internet and pasting them into Word," he said. "Having a 17-inch screen will help because you can keep both those windows open and see what is going on."

Multimedia. Since the mid-1990s, software developers have used CD-ROM as their primary method to distribute their products. But CD-ROMs, which can hold 680 megabytes of data, are slowly being displaced by DVD-ROM (the DVD stands for digital video disk), which can already store 4.7 gigabytes of data and will soon be able to store 17 gigabytes. To plan for the future, Dr. Carter recommended that physicians consider buying a machine with DVD-ROM technology, particularly as applications and data files continue to get bigger. He noted that DVD-ROM devices can play old CDs and will potentially be used for medical imaging data such as catheter films.


Howard Wolinsky is a Chicago-based freelance medicine and technology writer.

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