Putting the servers in client-server

Health Management Technology, Jan, 1997 by Lindsay Smith

There are a mind-boggling number of computer server choices. Doing your homework and evaluating the total hardware-software-network solution is the key to selecting the server that is best for your organization, experts say.

It seems like everyone in the healthcare information industry is talking client-server.

But deciding which server is right for your needs can mean wading through fact sheets and comparative grids loaded with lingo about cluster nodes, RAID levels, bus bandwidth, and hot swappable disks.

Manufacturers who put the "server" in client-server offer what can be a brain-numbing number of choices. An IBM booklet about RS/6000 server features lists 21 separate models. A Digital Equipment comparison chart about its Alpha System servers covers more than a dozen models. And a Sun Microsystems product sheet on its Ultra Enterprise Cluster servers includes ten boxes. (For help, see the article below.)

They come in all shapes and sizes, from PCs that you can get out of the box yourself to massive, top-of-the-line servers that you'll need help getting out of the box.

Picking a winner

For information systems managers who are more interested in the information that is processed by the machines, rather than what makes the machines tick, it is valuable to look at the entire hardware-software-network package.

And evaluating the whole package requires a basic understanding of why servers have become so important in the first place.

A move toward what is known as "three-tier computing" is one of the drivers, says Mike Cook, manager of integrated healthcare consulting services for Coopers & Lybrand, Chicago.

"The trend that you're seeing today is a three-tier architecture. That says, 'I have a computer that has all my data consolidated in one spot, I have a second computer that's called the application server that's actually doing the logic for payroll, order entry or whatever you want, and then I have my third piece which is the front-end accessing of that from the PC,'" Cook explains. "So I've really separated the logic from the data on the back-end."

"People are going with that approach because if you just have to change the application, you don't have to worry about all the data structure behind it," he says. "It's easier to manage. You can get data from several different application servers and other servers and by putting it all together, you can do management reporting. That's the power of the distributed model."

Cook says people like client-server technology because they are able to deploy new applications quicker and faster.

Client-server downside

But there is a downside to client-server systems, according to Cook.

In healthcare in particular, there's a tradeoff between flexibility and a rather formidable cost of ownership.

"In healthcare, as there's pressures to cut costs, recognize that this thing has a big hidden cost that you need to manage," Cook cautions. "The downside is that when you get to client-server and have networks and everything associated with that, the cost of ownership is enormous. Gartner [The Gartner Group, Boston] says that if you put in a network, while you only paid $2,000 for a PC, the annual costs to support that are somewhere between $10,000 and $20,000 a year.

"So if you're a hospital and you're going to put in 200 PCs, with a network so the PCs can talk to each other, the costs of ownership are much, much higher," he says. "The hope is that by using client-server, and particularly with clustering, you can at least begin to reduce your initial capital costs. So, CEOs and CIOs, while you've heard this stuff is sexy and you're going out and getting it, keep in mind there's this dirty little secret you'd better be prepared to deal with and have in place, or you're in for some trouble."

Cook adds that the majority of I/S buyers in healthcare buy turnkey solutions: accounting systems, clinical systems, whatever.

"Yet people always talk about buying software first or functionality first," he says. "My point is that lots of CIOs won't really focus on that. For the vast majority of the systems they buy, they won't focus on the functionality of a particular server. They're buying a complete solution from a particular vendor.

"On the other hand, there's another area like administrative support systems, e-mail, spreadsheets and groupware, Internet and intranet; those are areas where a CIO would be more inclined to buy hardware separate from software more frequently. In those instances, he or she might be more interested in the features of the server pieces."

Cook says he suggests what he calls a "fit-risk-cost" model of buying. Fit means how well it fits your needs. Risk is the vendor's reliability. Cost is the cost of equipment.

In the fit-risk-cost context, buyers tend to stay with the industry leaders, Cook concludes.

Risk and reward

If you're considering an investment in client-server technology, your first step might be assessing your tolerance for risk, suggests Mitch Work, a healthcare consultant and senior vice president at Dorenfest & Associates in Chicago.