When shopping for a computer, how much is enough?
Here's how to decide if you need the latest technology or just enough power and speed to get by
From the March 1998 ACP Observer, copyright © 1998 by the American College of Physicians.
By Howard Wolinsky
Gordon Moore, one of the founders of Intel Corp., long ago realized that the speed of computer processing power was doubling every 18 months or so. The downside of what has come to be known as Moore's law is that computer equipment quickly becomes obsolete. The upside is that prices for year-old technology tend to fall 50% every 18 months.
If you're in the market for a new computer, this realization puts you in a difficult position: Do you lay out thousands for a new system, or do you buy last year's technology at a considerable discount?
According to internists who are veterans of medical computing, a good way to get started is to determine exactly what you want to do with your new computer, then determine how comfortable you are with its inevitable obsolescence.
Roger D. Spitzer, ACP Member, an infectious disease physician in Miami, Fla., takes the low-cost approach. "If all you want is Medline searching and e-mail with some basic word processing, then any of the systems currently advertised for under $1,000 will do fine."
Other physicians like David K. Kumaki, FACP, a general internist in Norway, Maine, say that minimal systems are not worth their low cost because they will be obsolete within a year or two. Top-of-the-line systems, on the other hand, should be able to handle new software for at least three years with only minor upgrades. "The new class of sub-$1,000 machines is barely adequate for most uses and will quickly become frustrating for most people," Dr. Kumaki said. According to his estimates, physicians should plan on spending at least $2,500 to buy a system that will last three to five years.
To cut through some of the confusion—and the contradictory advice—we've assembled a list of basic computer elements and recommendations from medical computing experts. (This article doesn't talk about the Macintosh, but much of the technology is the same.)
- The microprocessor. The microprocessor includes the central processing unit (CPU), the "brain" that runs computers and accounts for about half of their cost.
Pentium-class CPUs—the most current technology—run at speeds of 100 megahertz (MHz) to 333MHz. (Consistent with Moore's law, 500MHz and 1,000MHz processors are on the horizon.) Pentium microprocessors succeeded the older 486-chip units and run twice as fast. The Pentium Pro and Pentium II processors are the fastest versions of the Pentium processor, with the Pentium II running at speeds of up to 333MHz.
Pentium processors are manufactured by Intel, but there are other choices. Comparable—and less expensive—processors are made by competitors such as Cyrix and Advanced Micro Devices (AMD). Experts rate these other microprocessors highly and suggest that buyers consider them when buying a machine.
So what do you need? While nearly all experts agree that 486 processors are too slow for current software, you still need to decide whether to purchase the latest and greatest—or just enough processing power to get by.
Daniel R. Masys, FACP, director of biomedical informatics and associate clinical professor of medicine at the University of California, San Diego (UCSD) School of Medicine takes the minimalist approach: "In general, there are few medical information applications that require the highest performance hardware, so I usually recommend that physicians purchase the machine that would have been top of the line six to 12 months ago." If you're shopping for a Windows machine, he would recommend a 100MHz Pentium-class processor.
Not surprisingly, there is disagreement. Paul I. Roda, FACP, a medical oncologist from Hazelton, Pa., suggested purchasing a bit more power: a machine with a 200 MHz processor to take advantage of some multimedia applications.
- Random access memory (RAM). Just as important as processor speed is RAM, the working memory that allows you to run applications. Theoretically, new PCs can get by with eight megabytes (MB) of RAM—you'll need at least that much to run Windows 95—but 16MB or 32MB is more realistic.
If you want a higher-end machine, Dr. Roda suggested bumping up to 32MB. According to UCSD's Dr. Masys, most medical office applications require 32MB: 16MB to run the operating system and another 8MB to 16MB to run themselves.
Another reason to go with some extra RAM is to make surfing the Internet and the World Wide Web faster. Dr. Kumaki suggested at least 32MB of RAM to view memory-intensive graphics.
- Hard disk. Not that long ago, the capacity of hard disks—the device that stores data—was measured in thousands of bytes, or kilobytes. (Early hard disks commonly had 512K of storage space.) Today, however, hard disks are ranked in millions of bytes, known as gigabytes (GB), and keep a lookout—even trillions of bytes, known as terabytes (TB)—will become available eventually.
A 1TB hard disk may sound excessive, but software developers are creating huge applications (known as "bloatware") that consume more and more disk space. Even basic word processing software now consumes up to 100MB of disk space, so you'll probably want a hard disk that has at least 2GB.
But is 2GB enough? For now, the answer is probably yes. According to Dr. Masys, a 2GB hard disk should be more than adequate to hold clinical data, as long as it does not contain many clinical images like X-rays. As a rule of thumb, Dr. Masys said, most physicians will accumulate between 5K and 50K of patient data per year.
Dr. Kumaki, whose office runs a billing application containing more than 15,000 accounts, agreed that a 2GB hard disk is more than adequate. Both Drs. Kumaki and Masys believe that in the near future, however, larger hard disks—4GB to 7GB, for example—will become standard.
- Back-up. Disk drives are destined to fail at some point, so you need a back-up system. Because most physicians store only small amounts of data, Dr. Masys suggested using removable disk drives like Iomega's popular Zip Drive to store data safely away from your hard drive. The drive itself sells for about $200; individual disks for the drive sell for about $15 and hold 100MB of data. There are also digital tape drives that cost about $200 and hold 1GB of data.
Experts like Dr. Masys say that the individual drive that you decide to use is far less important than the discipline of doing regular backups. How often you should back up your hard disk? Dr. Masys suggested determining how much data—a day, a week, a month?—you can afford to lose. Then, get in the habit of backing up your data.
- Monitors. Again, unless you regularly read images like X-rays, a standard color monitor is sufficient. Size is an issue; standard 15-inch monitors cost about $550, 17-inch units go for about $850 and 21-inch monitors cost about $1,400. Experts say to look for a dot pitch of .28 or less, a refresh rate of 75Hz or more and 800x600 resolution.
- Modems. To connect your computer to the Internet, you'll need a modem, which typically costs between $100 and $200 for a high-speed analog device. Modems are available in a variety of speeds and models and range from lower-end units that transfer data at speeds of at least 28.8 kilobits per second (kbps) to high-speed 56.6 kbps models. There are also higher-speed modems—integrated services digital network (ISDN) and digital subscriber lines (DSL)—that use existing phone lines to transfer information at extremely high speeds.
Before embracing any of these new high-speed technologies, however, check with your Internet service provider or anyone else with whom you communicate via modem (your hospital system, for example). Dr. Roda, the oncologist, pointed out that not all 56kbps modems, for example, use the same standards, so you need to make sure your new equipment will be compatible with the other users with whom you connect.
- Printers. If speed is not an issue, the consensus is to go with color inkjet printers. Inkjet printers cost less than laser printers—$400 vs. $1,000 and up—but supplies cost more per page. The major difference, though, is that laser printers offer higher speed and better resolution than inkjet printers.
Dr. Roda suggested the following strategy: Use a color inkjet printer at home (color makes great transparencies for lectures) and use a laser printer at the office for letters and other business transactions.
- Multimedia. Finally, there is the issue of multimedia technology. Virtually all new computers come with special graphics and audio cards that allow you to listen to sound and watch moving images, but new features are constantly being developed to make multimedia work even better. MMX technology, for example, speeds up video, audio and graphics on computers, a feature most useful for playing games. Experts, however, say that few medical software applications require or use MMX technology, so it is not really necessary.
Howard Wolinsky is a Chicago-based freelance medical and technology writer.
Computer hardware: a glossary
Bit —the abbreviation for binary digit, the smallest unit of information a computer can hold. The value of a bit is 1 or 0.
Bit rate —the speed at which bits are transmitted, in bits per second. Modem rates are measured in kilobits, or 1,000 bits per second (kbps).
Byte —the amount of RAM or hard disk space used to store one character, which is usually eight bits. Related terms include kilobyte, which represents 1,000 bytes; megabyte (MB), which represents one million bytes; gigabyte (GB), which represents one billion bytes; and terabyte (TB), which represents one trillion bytes.
Central processing unit (CPU)—the unit that controls the operation of a computer.
Digital subscriber line (DSL)—a family of technologies that use existing copper phone lines to download data. DSL is 20 times faster than conventional modems.
Integrated services digital network (ISDN)—digital telecommunications lines that can transmit both voice and digital network services. ISDN technology can download data about five times faster than conventional modems.
Megahertz (MHz)—the frequency of the speed of a computer in millions of cycles per second. It is a measure of computing power.
Modem —the device connecting computers to each other via telephone lines. The modem modulates the digital data of computers into analog signals to send over telephone lines, then demodulates the data back into digital signals.
Operating system —the main control program of a computer, such as Windows.
Random access memory (RAM)—a computer's working memory. RAM allows computers to operate software.
Other glossaries: The Free On-line Dictionary of Computing at http://wagner.princeton.edu/foldoc/about.html , Computer Currents online dictionary at http://www.currents.net/resources/dictionary/dictionary.phtml .
Internist Archives Quick Links
Attention Lab Owners:
Get Live Answers at a Price You Can Afford
MLE offers ACP members superior service, affordability, online options and other special features.
