Workstation, laptop or tablet? This month we'll discuss the hardware through which you'll access your electronic medical records. Keep in mind that many facilities employ combinations of these options.

• Workstations. Not only is this your least expensive option — desktop units cost less than $400 — but their fixed locations on stands, wall-mounts or booms also lend stability and security. On the downside, a workstation can't follow a provider or patient through the surgical process and they aren't immediately interchangeable in the event of device failure.
• Laptops. A laptop mounted on a wheeled cart makes for convenient use. While it's easily moved where needed, this setup may clutter the limited space of a pre-op or PACU bay. Powering and battery charging requires proximity to electrical outlets. Suitable models can be obtained for less than $700.
• Tablets. Tablets let you use EMRs like paper charts. As long as their batteries are charged, their portability lets you carry administrative resources wherever the perioperative process takes you. Portability also puts them at risk of loss, theft or damage, so their purchase — which may total $2,000 each — should include service agreements and security software.

Connectivity and control
The rise of mobile computing in surgical environments has made wireless networking less an option and more a necessity. Laptops and tablets require the installation of a wireless router and antennas, or "hotspots," in addition to the server's wiring and switches. Your software vendor can provide you with the hardware specifications, and installers should test for network saturation, reliability, security and interference. "You have to test for connectivity everywhere," says Christi Rousseau, RN, clinical analyst for Magnolia Regional Health Center in Corinth, Miss. "One mobile device might work in OR 1, but not work in the corner of OR 3."

Installation cost depends on the size of your facility, since larger sites require more hotspots. "Network hardware and installation can be very costly, but a bad installation is more costly," says Mark Bingaman, IT applications specialist for Harmony Surgery Center in Fort Collins, Colo. So an experienced technician with an eye on user demands, system obstacles and future needs is highly recommended.

The selection of a server to anchor, control and house your EMR system depends on your case volume, whether you're a standalone center or part of a health system's IT network, whether you'll use the same server that's hosting your practice management software or a separate machine, and other technical considerations. "Server hardware is in a sense pre-trialed, because most IT people and organizations are already aware of what they would like to go with," says Mr. Bingaman. If you're following software vendors' recommendations, though, due diligence to ensure reliability, security and efficient power usage is advisable. Servers can range from $5,000 to $20,000 depending on configuration, storage capacity and speed.

Practical peripherals
In addition to the main hardware components necessary to run an EMR system, you may find the following peripherals useful, says Brad Boyd, vice president of Culbert Healthcare Solutions, a Woburn, Mass., management consulting firm:

• Printers and page scanners. Especially during the early stages of your conversion to EMRs from paper charts.
• Bar-code scanners. For quick and accurate medication and supply documentation.
• Dual-screen workstations. Allowing simultaneous imaging and charting.

Beyond installation, beyond training, don't neglect the importance of EMR hardware upkeep through system maintenance, routine repairs and phased upgrades. "Preventative maintenance is a cost-effective means of ensuring a stable system environment and identifying potential risks before they lead to unexpected downtime," says Mr. Boyd. "Proactive replacement is far less disruptive to the end user than sporadic outages caused by dated hardware."