It doesn't matter whether your practice is just one doctor at one location, or a number of physicians across a multi-office network. Either way, to realize a successful electronic medical records system (EMR), you'll need to start by developing the system infrastructure, the physical 'guts' of the network, if you will.

Usually a contractor will take care of the network wiring at your office and multi-office network. It is wise to select a contractor that has been certified by the Building Industry Consulting Service International (BICSI). Certified contractors will be well-versed in the terms and issues at the present moment, and could help avoid a surprise like an incompatible connection or the need to pay high labor costs to repair a network which was not designed correctly in the first place.

Examine the specific needs of every individual location:

SECURITY: Don't forget security! Make the wiring closet secure, and remember that anyone with access to this closet can dismantle your network at any time.

COOLING: Network and server equipment create abundant heat and also tend to shut down when over-heated. Plan for this heat by making sure you have adequate cooling at the ready; you may consider installing a small air-conditioning unit.

WIRELESS: Considering wireless networking, also known as WiFi? If you are, you will have to choose a standard: 802.11a, 802.11b, 802.11g, or 802.11h? There are newer standards which provide higher data transfer speeds, but these systems cost significantly more. The wireless standard that you select should depend on whether you're running a thin or fat client.

OVERWIRE: Most existing buildings are wired above the ceiling. Wiring is then dropped down the walls. When wiring, we recommend 'double drops,' as the largest cost of wire installation is the labor. If, when wiring, everywhere you think of a network connection, you wire two drops, you will thank yourself when you want to annex more network devices (networked printer, time clock, wireless access point, kiosk, for example). It's wise to consider installing a network drop wherever you anticipate the placement of diagnostic equipment, as this will help facilitate future interface needs.

ELECTRICITY: It's standard IT practice to spend a bit extra to have a certified electrician install circuits for your network and servers. Typical Cat5e wires have either T568A or T568B as a standard. Select either one and be sure everything is wired to the same standard. The Cat6 wire standard is newer and a bit more expensive, probably a bit overkill for most medical practices. Copper wires between telephone communications closets should not contain segments longer than a hundred meters.

Consider using fiberoptic cable for longer wiring distances, as these cables can move more information and is not as vulnerable to interference and effects from lightning. Fiberoptic is a bit more expensive, however.

To make a connection between remote offices, you'll have to create a wide-area network, or WAN. By doing your homework, you should be able to get a clear sense of the wide-area network options which are available to you. In most cases, large metropolitan areas have better options for wide-area networking.

LOCAL PHONE SERVICE: Meet and understand your local service technicians and sales people. They understand the technological offerings in your geographic area. Some points to consider include T1 lines: would a Point to Point (PTP) or Metropolitan Area Network (MAN) be more beneficial? Be sure to inquire about both burst and committed info rates. A fast T1 connection may not be enough for your needs if the max is not there when you need it most. Will the phone company supply and maintain the router hardware, or is that your responsibility?

FIBER BACKBONES: Local utilities commonly maintain a fiber backbone which they allow businesses access to. These fiber backbones can create options for high (10-100Mpbs) bandwidth rates between office locations at rates that are quite competitive.

The cost of a network infrastructure is much lower in a new building. Actually, the ability to oversee the creation of network wiring in a building under construction is a huge advantage for clear design and reduced costs. However, the majority of practices will be located in an existing building, and especially in these cases, sound design and forethought in infrastructure planning will help save your practice from the costs and disappointment of a network design blunder.