Remote application, low bandwidth vpn link

[XOR != OR]

Hi folks, got something of a kicker of a problem here. Hoping you all might have some insight.

I have two dental offices, hence two networks, that I administrate. The first, main office, has 30+ pcs. The second office has 10. These offices are connected via a vpn ( openvpn ). The main office, however, is in a piss poor part of town in terms of bandwidth. The best I can hope for here is a t1 running ~ 600 bucks a month. The other office is pretty well connected however.

We run a practice management software application. It stores things like patients, transactions, notes...ect. We want to run this off of one database. Normally, I'd just do remote desktop across the vpn ( full t1 ) and we'd be in good shape. The downside is, of course, that we want to go chartless/paperless. This will force us to use fat clients instead of doing remote desktop. Which is where I am stuck right now. I do not have the bandwidth at the main site to do this, and while I do have a well connected second office, I have 30+ pcs at the main office that would all need to be fat clients as well. And the best I can hope for is a full t1 at that site.

So I'm stuck. I've talked with all the local internet providers ( comcast, arrival and yes...even sbc. I feel slimy having done so ), and it's not a problem on their end, it's ours. We are WAAAAYYY far away from the nearest telco office, and the nearest cable drop is over a mile away. Due to latency, satalite isn't an option, and the only wireless ISP in the area drops packets like it was playing hot potato with them.

I'm thinking until the bandwidth situation changes, I'm sol here, but I'd like a second opinion. Please ask for clarification if I've garbled something ( I've got the caffiene jitters right now...heh..and I like it )

 

[oakfan52]

why won't a thin client solution like Citrix work?

 

[oakfan52]

Oh another idea.....we use this at one clients site. get a P2P T1 connecting the sites. We use a P2P T1 from the remote office to the HQ. They remote officae all usues citirx over the p2p T1. Then we also have a T1 to the internet at the HQ.

 

[XOR != OR]

why won't a thin client solution like Citrix work?

Well, that's a damn good question. First, let me tell you what we need the clients to do:

For a paperless office, we will need patients to sign electronically. Right now, we have signing pads and a few tablet PCs with touch screens. We will also be scanning documents in to the system and attaching them to patient records. Further, we will be running a seperate xray software package that will be linked to the database. I'm not sure how that would work with citrix.

This won't work with remote desktop, according to our software provider ( although I plan on testing that as soon as I get the software ).

I don't know how citrix works, and I am currently looking into it. Do you know if it can handle input from a touch pad? And I'm guessing the document scanning is simply out of reach, due to the bandwidth needed to transfer the images.

 

[oakfan52]

The only possbile catch i see is the document signing. touchpad. I have neverwork with those. The X-ray DB shouldn't be an issue because i wouldn't use citrix for that. Maybe nybbles can jump in on this in that aspect because we did a network for a dentist office that has networked xray but he knows more about the sw than i. As far as i know it uses IP to connect to the DB server so if you went P2P T1 your two sites should be configured to communitcate accross the link.

Can you give me anymore information on how the touchpad devices work?

If all else fails how BW intensive would it be just to run the whole network over a P2P T1 wan link?

 

[XOR != OR]

The only possbile catch i see is the document signing. touchpad. I have neverwork with those. The X-ray DB shouldn't be an issue because i wouldn't use citrix for that. Maybe nybbles can jump in on this in that aspect because we did a network for a dentist office that has networked xray but he knows more about the sw than i. As far as i know it uses IP to connect to the DB server so if you went P2P T1 your two sites should be configured to communitcate accross the link.

Can you give me anymore information on how the touchpad devices work?

If all else fails how BW intensive would it be just to run the whole network over a P2P T1 wan link?

Is a p2p t1 more bandwidth than a normal t1? Otherwise, I can't see 1.5mbit being enough for 10 fat clients. One would be stressing it severely, and we want to run voip over this line in the future.

I don't yet know how the touchpads ( sig pads really ) work, the vendor is less than forthcoming about that bit, tho whether thats from ignorance or malice I can't say ( and sadly, I'm used to that from vendors...).

 

[df12]

How about, a DB server in both locations, then setup data replication between the 2 DB servers? I don't see a reason to send all the transactions back and forth, just changes to the DB.

I guess that really brings up another question, what type of Database are you running?

 

[XOR != OR]

How about, a DB server in both locations, then setup data replication between the 2 DB servers? I don't see a reason to send all the transactions back and forth, just changes to the DB.

I guess that really brings up another question, what type of Database are you running?

I had thought of this, but future plans include a business office which will need immediate access to all the data in the database. If I post a payment in location A, I need to be able to access those details from location B.

Further, I did think about replication maybe once an hour ( an hour delay would still be "violating" the requirements, but I think i could talk them into it ), but the office software doesn't support the replication. It's built on top of a pervasive database, which I think supports replication, but the software itself can't handle it.

 

[oakfan52]

what is the touchpad interface? citrix can map serial ports to clients aswell as parallel. I think a citrix soltuion seems like just what you need if the application will run in a TS invironment.

 

[XOR != OR]

what is the touchpad interface? citrix can map serial ports to clients aswell as parallel. I think a citrix soltuion seems like just what you need if the application will run in a TS invironment.

I will look into it ( I've got a call into a local software rep for citrix, as a matter of fact ).

Thanks for the idea, it's apprecaited to be sure.

That still leaves the actual document scanning, but I can't see any way around the bandwidth issue on this point. At some point, the document is going to have to be sent to the server over the link from the remote location. No way around it

 

[Boscoh]

We have used Citrix with an SSL proxy from Juniper over Starband and Direcway satellites with very little latency issues, especially with the Direcway 6000 series modems. Citrix has a product built into it that takes care of most latency problems, and Citrix itself uses very little bandwidth.

I would think that given the presence Citrix has in the healthcare industry, they'd have a solution for the signature/touchpad issue.

You are correct though that at some point, the document is going to have to be scanned and sent to the other office. However, you could compress these images and/or possibly archive them into a zip or rar format and batch them overnight when no one is using the link.

 

[SJConsultant]

XOR != OR , which Dental and Xray applications are they using ?

Dentrix? Eaglesoft? CDR Dicom? etc.

I am working with a couple dental offices in my area with similiar issues for the past few weeks and will give whatever information I have.

 

[XOR != OR]

XOR != OR , which Dental and Xray applications are they using ?

Dentrix? Eaglesoft? CDR Dicom? etc.

I am working with a couple dental offices in my area with similiar issues for the past few weeks and will give whatever information I have.

Windent and Schick CDR Dicom.

And I'd apprecaite it.

 

[Nybbles]

The only possbile catch i see is the document signing. touchpad. I have neverwork with those. The X-ray DB shouldn't be an issue because i wouldn't use citrix for that. Maybe nybbles can jump in on this in that aspect because we did a network for a dentist office that has networked xray but he knows more about the sw than i. As far as i know it uses IP to connect to the DB server so if you went P2P T1 your two sites should be configured to communitcate accross the link.

Well, the Dentist that Oakfan and I did work for was using a Digital XRay system by Sidexis. The machine just had a small main box with an ethernet interface on it. Each unit had an IP and it plugged into the switch right alongside all the PC's. The software is installed on each PC, and it just pulls data from and dumps data into a share on the server. Given this fact, I dont see any reason why it couldnt run over a VPN connection.

However, my concern would be the size of these X-Ray images saturating that T1 too easily. Currently, each X-Ray image is a TIFF file measuring nearly 400 KB! Multiply that by the number of images per visit, by the number of patients per day, etc... and u'll quickly see that if your x-ray machine(s) are kept busy, it will put quite a spikey demand on your T1.

The other thing u might look at would be to see about synchronizing the large data nightly, however, this project was just a single-office implementation, so I never had to look into that. There was initially plans for a second office, however, that has since changed. It looks like the images are just stored in directories below directories, etc, but there is an MDB file in there, which I have not opened up outside of the program. That MDB file would probably complicate merging the data nightly.

I'll pop back on this thread and re-read later when i'm not in a rush to get out of work for the weekend.

Edit: Of course as soon as I hit 'Post' the question was answered which makes much of what I said irrelevant.

 

[SJConsultant]

Windent and Schick CDR Dicom.

And I'd apprecaite it.

Ok,

I have no experience with Windent, but from what I know, none of the dental applications will run well over a WAN connection. Both offices I am working on now have T1 connections that are near perfect for bandwidth and latency. During offhours testing the applications were still slow to load and do any kind of DB searchs.

Shick's CDR Dicom does pretty well with moving images over the T1 since I've only seen a max image size of around 350Kb. Searches or browsing the DB is a whole different story, still slow with a T1.

Also, I have talked extensively with tech support from two companies with both of them saying they do not recommend nor support running their applications on a terminal or citrix environment.

Neither Eaglesoft or Dentrix have any configurations that will do database replication and since both systems use their own DB server (Pervasive I think?), it is not feasible to use or convert to MS SQL with replication.

All in all a T1 is not a viable option for any of the major dental software packages out there. Maybe a load balanced configuration using SDSL or T1s would help, but I would recommend doing some long term bandwidth monitoring of the WAN connection and a few LAN connections using MRTG or similiar. Once you establish some LAN bandwidth baselines you'll have a better view of what is needed and what might work.

I can't fathom why the software vendors don't include options for branch office operations seeing as they are quite frequently needed and the relative expense of the software.

 

[XOR != OR]

Ok,

I have no experience with Windent, but from what I know, none of the dental applications will run well over a WAN connection. Both offices I am working on now have T1 connections that are near perfect for bandwidth and latency. During offhours testing the applications were still slow to load and do any kind of DB searchs.

This much I suspected.

Shick's CDR Dicom does pretty well with moving images over the T1 since I've only seen a max image size of around 350Kb. Searches or browsing the DB is a whole different story, still slow with a T1.

This too, was expected. I can do image transfers ( rsync from the samba server they live on. Shhh, dont' tell Schick. They about popped a blood vessel when I told them I was considering it. ) just fine, and I can even import/export the records from the remote office to the main office, but it's not practical.

Also, I have talked extensively with tech support from two companies with both of them saying they do not recommend nor support running their applications on a terminal or citrix environment.

Well, no, they wouldn't. I wouldn't either in their case. It's a completely different kettle of fish if it works tho.

Neither Eaglesoft or Dentrix have any configurations that will do database replication and since both systems use their own DB server (Pervasive I think?), it is not feasible to use or convert to MS SQL with replication.

Dentrix actually has a system that runs on mssql: Dentrix Enterprise. It's basically dentrix 6.0 with tons of bugs and mssql support. Seriously. And anyway, that wouldn't work either, we have it, and we want away from them. All I know about eaglesoft is they wouldn't return my calls about buying it.

All in all a T1 is not a viable option for any of the major dental software packages out there. Maybe a load balanced configuration using SDSL or T1s would help, but I would recommend doing some long term bandwidth monitoring of the WAN connection and a few LAN connections using MRTG or similiar. Once you establish some LAN bandwidth baselines you'll have a better view of what is needed and what might work.

My thought as well. I'm just going to have to find a way to get more bandwidth to the main office.

I can't fathom why the software vendors don't include options for branch office operations seeing as they are quite frequently needed and the relative expense of the software.

This has bugged me extensively as well. It's not uncommon to have multiple offices for the same practice, so why they haven't built a system to accomodate this yet is beyond me.

It's not even like it'd be that hard. You focus on making your database queries lightweight, or you build the system so you can have master and slave data servers. Not all that difficult, and I know enough about programming to understand what is involved in that statement.