ConfiguringEnvironmentsfor athenaPractice™v20...TableofContents ConfiguringEnvironmentsforathenaPractice™v20 1 Hardwareandsoftwareplanningconsiderations 1 Upgradeoptions 1 Implementationscenariosbyclinicsize

Configuring Environments forathenaPractice™ v20

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November 2020

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Table of Contents

Configuring Environments for athenaPractice™ v20 1Hardware and software planning considerations 1Upgrade options 1Implementation scenarios by clinic size 2Small - Up to 25 concurrent users 2

Medium - 26 to 499 concurrent users 3

Large - More than 500 concurrent users 4

Virtual environments 5Database server 6Database server software 6

Database server hardware 8

Processor, RAM, and disk space 8

Dedicated database server required 8

Disk setup for performance and reliability 8

Network interface cards/switches 9

Network protocol 9

Application server 9Application server software 10

Application server hardware 11

Data Exchange server 11Data Exchange server software 11

Data Exchange server hardware requirements 12

High data transfer rate considerations for DTS 12

Client workstation 13Client workstation software 13

Incompatible products 14

Client workstation hardware 14

Remote Desktop Services/Citrix server/client 15Impact of network infrastructure 16

Remote Desktop Services/Citrix server software 16

Citrix 16

Microsoft WindowsRemote Desktop Services environment 16

i

Remote Desktop Services/Citrix server hardware 16

Unsupported configurations/features in RDS/Citrix 17

C-Now web browsers 17Third-party integration server hardware and software 18Server/workstation hardware for third-party software 19Integrated Faxing (Chart) 21Important features and system settings 22Enabling Chart clinical auditing features 22

Storing images 22

Getting technical support 22

ii

Hardware and software planning considerations

This document contains hardware and software configuration information forathenaPractice.

The configuration recommendations in this document may change atany time without notice.Check the athenaFlexCustomer Portal regularly for updates to this document.

Important. Only the software and configurations specified in this document have beentested with this release. If you use other software or configurations, ensure that youthoroughly test your configuration in a non-production environment.

Hardware and software planning considerationsTo prepare for installation or upgrade, youmust define, order, set up, and test allrequired hardware, software, and networks.

To determine your hardware requirements, youmust consider how your organization willimplement this product, including the scope of your application database requirements.Refer toCalculating Hardware Requirements for athenaPractice (Microsoft Excelspreadsheet available on the athenaFlexCustomer Portal) for details.

Consider the following when planning:

l Plan for productivity and growth.Your hardware budget should realisticallysupport your organization’s goals. If you plan to use older equipment, confirm thattheymeet theminimum requirements for the application. Regularly review andupdate your hardware tomeet changing needs.

l Set up at least one workstation for testing.Not all workstations need be in placefor the server to be installed and software loaded. However, you'll need at least oneclient workstation to test network connectivity and software.

Use Services consultants when planning system hardwareContact Services for help understanding and planning your equipment needs.Also plan to work closely with your clinic teams as they develop new workflows.

Upgrade options

Supported upgrade paths:

l athenaPractice 12.3.x and v19.x can upgrade directly to v20.

l Earlier versionswill require multiple upgrades to get to v20.If you are upgrading from an earlier version, contact Sales for information aboutupgrade services and support options. If you self-upgrade and encounter

athenaPractice™ 1©2020 VVC Holding Corp. All rights reserved.


https://athenaflex.athenahealth.com/

https://athenaflex.athenahealth.com/s/hcd-librarypage?Id=0686f000007x8lF

Implementation scenarios by clinic size

problems, limited troubleshooting support and, if necessary, help rolling back tothe previous version are available.

For Service Pack upgrades, refer to the release notes for the appropriate upgradepath.

Implementation scenarios by clinic sizeThe following sample scenarios are based on common implementations of hardwareconfigurations anticipated for small, medium, and large environments.

TheServer Configurator utility simplifies this planning and setup. Launch ServerConfigurator fromServer Setup to plan and implement your configuration.

These scenarios are not intended to be a comprehensive list of all products youmight include in your implementation.

Small - Up to 25 concurrent usersRecommended configuration for small clinics. The client runs on separateworkstations and other application components are hosted on servers:

l Database ServerathenaPractice database, MIK (Millbrook Interface Kit), and athenaPracticeAnalytics. MIK can also be installed with Data Transfer Station.

l Application/JBoss Server (Single Server Role)JBoss, Service Layer, and applicationWeb site.

l Data Exchange ServerOptional dedicated server for clinical data exchange with Data Transfer Station(DTS) and optionallyMIK andQIE.

l Qvera interface engine (QIE)Requires dedicated server. If fewer than 75 providers, may be installed together withDTS on the Data Exchange Server.

l ePrescribingRequires dedicated Surescripts eScript Messenger (eSM) server until you activatethe new MedicationManagement module. This server is not needed after activatingMedicationManagement.

l Imprivata (EPCS and SFA)Imprivata appliance VMs support Electronic Prescribing of Controlled Substances(EPCS) or Single Factor Authentication for prescribing (SFA). Virtual machines areprovided by Imprivata and hosted on Hyper-V or VMWare. This is not needed afteractivatingMedicationManagement.

l Client workstations



Medium - 26 to 499 concurrent users

Follow industry standard IT configurations for security and reliability that installdatabase and application servers to separate hosts.

Medium - 26 to 499 concurrent usersRecommended configuration for medium clinics.Separate servers host mainapplication components.

l Database ServerOne or more athenaPractice databases on a dedicated server with MIK (MillbrookInterface Kit), and athenaPractice Analytics. MIK can also be installed to a separatemachine.

Larger environmentsmay requiremultiple athenaPractice databaseinstances tomaintain separate patient charts among different groups ofphysicians. Thismeans that multiple application web sites run under theService Layer, each connected to a separate database.

l Single Application/JBoss server (under 100 concurrent users)Single server provides client application processing, application web sites, client webservices, and interoperability processing. Two servers are recommended for over100 concurrent users.

l Multiple Application/JBoss servers (200 + concurrent users)

l Interop server - Processing for quality reporting subscriptions and access toFHIR resources.

l GUI server - Client application processing, application web sites, client webservices.

An additional GUI server is recommended for every 200 concurrent users.For example, 500 concurrent users requires 3GUI servers and one InteropServer.

l Load Balancer - One server supportsmultiple GUI servers.

l Data Exchange ServerOptional dedicated server for clinical data exchange with Data Transfer Station(DTS) and optionallyMIK.

l Qvera interface engine (QIE)Optional dedicated server for interfaces and subscriptions handled byQIE. If under75 concurrent users, QIE, MIK, and DTS can be installed together.

l ePrescribingRequires dedicated Surescripts eScript Messenger (eSM) server until you activate



Large - More than 500 concurrent users

the new MedicationManagement module. This server is not needed after activatingMedicationManagement.



Large - More than 500 concurrent usersThis is often an ASP or thin client environment running under Citrix or Windows TerminalServer with multiple Database servers andmultipleWeb sites.

Recommended configuration for large clinics. Separate servers host mainapplication components.

l Database Server(s):One or more athenaPractice databases on one or morededicated servers, MIK (Millbrook Interface Kit), and athenaPractice Analytics. MIKcan also be installed to a separatemachine.

Larger environmentsmay requiremultiple separate athenaPracticedatabases tomaintain separate patient charts among different groups ofphysicians. Thismeans that multiple application web sites run under theService Layer, each connected to a separate database.

l Multiple Application/JBoss servers

l Interop server - Processing for quality reporting subscriptions and access toFHIR resources. Limit one Interop server per database.

l GUI server(s) - Client application processing, application web sites, client webservices.

An additional GUI server is recommended for every 200 concurrent users.For example, 500 concurrent users requires 3GUI servers and one InteropServer

The number of required GUI servers is calculated using theCalculatingHardware Requirements for athenaPractice spreadsheet.

l Load Balancer - One server supportsmultiple GUI servers.

l Data Exchange ServerOptional dedicated server for clinical data exchange with Data Transfer Station(DTS) and optionallyMIK.

l Qvera interface engine (QIE)Optional dedicated server for interfaces and subscriptions handled byQIE.



Virtual environments

l ePrescribingRequires dedicated Surescripts eScript Messenger (eSM) server until you activatethe new MedicationManagement module. This server is not needed after activatingMedicationManagement.



Virtual environmentsIn server virtualization or virtual environments a physical host operating system supportsone or more guest operating systems or virtual machines (VM).

Use server virtualization with your hypervisor software. This version of athenaPracticewas tested with the following at the time of initial release:

l VMware

l Microsoft Hyper-V Server

Server virtualizationWhen evaluating performance in a virtualized environment, measure performance ofhost systems aswell as VM systems.

A key component in configuring a VM system is the number of allocated virtualprocessors (vCPUs). The number of vCPUs available to VMs is determined from thehost hardware. To calculate this precisely in your environment, refer to theCalculatingHardware Requirements for athenaPractice spreadsheet.

Allocate vCPUs per VM as specified on the virtualization servers. Performancecan be degraded by oversubscribing vCPUs or RAMon the host.

Reserve VCPU andRAM for DB server, and JBossGUI and Interop serversunder your VM infrastructure as recommended inCalculating HardwareRequirements for athenaPractice spreadsheet for optimal performance. Contactyour IT administrator for hardware reservation details.

Hosts and guestsHost refers to the physical operating system supporting one or more VMoperatingsystems.GuestVM systems support the database, application servers, and third-partyintegration products. Refer to the following sections on physical servers for softwarerequirements.

Every implementation requires a different combination of VM operating systems.Allocate VM operating systems across the host operating systems. Balancing how VMs



Database server

use CPU, memory, disk, and network across the available hosts will improve theperformance of the product.

Database serverDatabase server refers to the dedicatedWindows server or VM hosting the product andSQL Server software, where all clinical and practicemanagement data is stored.

A demonstration (training) database can be installed on a supportedWindowsServer system and a full version of Microsoft SQL Server for testing and usertraining. See Database server software.

Review the following information and refer to theCalculating Hardware Requirementsfor athenaPractice spreadsheet before purchasing and configuring equipment. Therequirements for satisfactory performance of other softwaremay be higher. Equipmentperformance depends on processor speed andmemory configuration. It is not advisableto run other applications or programs on this server since thismay cause performancedegradation.

Database server softwareThis version of athenaPractice was tested with the following at the time of initial release.

Microsoft Windows OS for database serverValidated versions:

l WindowsServer 2012 R2

l WindowsServer 2016 Standard/Datacenter 64-bit

Microsoft .NET FrameworkValidated versions:

l .NET 4.7.2 (installed with the product)

l .NET 4.8

Microsoft SQL Server database (Standard or Enterprise platforms)Validated versions:

l SQLServer 2016 SP2

l SQLServer 2017

l SQLServer 2019

Active Directory and Azure Active DirectoryActive Directory (AD) is used for authenticating users on the system.

Azure Active Directory (AAD) is used for authenticating access to athenaPractice APIs,which is required in v20 for:



Database server software

l Electronic prescribing (with new MedicationManagement module)

l Appropriate Use Criteria (AUC) checking for orders

l Generating CCDA 2.1 documents

l Meeting the Provide Patients Electronic Access to Their Health InformationPromoting Interoperabilitymeasure

l TheC-Now mobile application

AD Connect is typically used to keep configuration synchronized between AD and AAD.

athenaPractice Analytics (formerly Centricity Analytics)athenaPractice Analytics 20.0 on SQL Server 2016 SP2*, 2017, or 2019**.

*If you are using athenaPractice Analytics on a server running SQL Server 2016 SP2,use SQL Server Management Studio (SSMS) 16.5.3. Do not install SSMS v17 or later.

**SQL Server 2019 requiresWindowsServer 2016 or greater.

Web browserMicrosoft Internet Explorer 11 (32-bit) StandardMode

Network protocolTCP/IP Only

Other database/Web server softwareThe following applications are required on your database Server or web server tosupport the athenaPractice website:

l SQLServer Utilities

Starting with SQL Sever Management Studio (SSMS) 18.x, Microsoft no longerbundles the command line utilities with SSMS. To use SSMS version 18.x or higher,you will also need to install the ODBC Driver and the Command Line Utilities:

l ODBC Driver 13 for SQL server

https://www.microsoft.com/en-us/download/confirmation.aspx?id=53339

l Microsoft Command Line Utilities 13 for SQL server

https://www.microsoft.com/en-US/download/details.aspx?id=52680

l MSXML 6.0

Software interfacesIf you plan to exchange clinical data with external systems or applications, Data TransferStation (for LinkLogic clinical data exchange), LinkLogic folders, andQvera interfaceengine are installed on separate servers. See Data Exchange server.

MIK is typically installed on the database server. If you runMIK on the databaseserver, Microsoft SQL Server 2012 Native Client must also be installed. MIK can



https://www.microsoft.com/en-us/download/confirmation.aspx?id=53339

https://www.microsoft.com/en-US/download/details.aspx?id=52680

Database server hardware

also be installed on the Data Exchange server.

Database server hardwareThe hardware recommendations are based on user loadswith only athenaPractice andClinical Content (CC) forms installed.

Application servers host the JBoss EAP application server, which in turn hostsathenaPracticeWeb sites, Service Layer, and FHIR API Server components.Services recommends hosting Database and Application server components onseparate servers.

Database hardware requirements vary considerably depending on the size andcomplexity of your implementation. To determine the requirements for your dedicateddatabase server, refer to theCalculating Hardware Requirements for athenaPracticespreadsheet.

Processor, RAM, and disk spaceChoose the fastest processor within your budget that is not less than the recommendedvalue. CPU selection is based on number of concurrent users. The systemmust supportthe required number of CPUs.

Disk setup is also based on number of concurrent users, number of patients (Chart), andhigh-frequency disk access.

Clinical items such as Medi-Span (20 GB) increase disk spacerequirements. Use the hardware calculator to make sure you have sufficientdisk space.

Dedicated database server requiredAt least one database server dedicated toMicrosoft SQL Server is required to run thedatabase. This server cannot be a domain controller or Remote Desktop Services/CitrixXenApp server.

While a small amount of file and print server activity can occur on the database server,Services recommends you use a separate server for other networked applications.Maintain at least 200GB of free space on the database server for optimal performance.

Disk setup for performance and reliabilityDisk arraysSAS or Fibre Channel RAID 1+0 disk arrays (DiskMirroring with Striping) increasedatabase disk performance and reliability and lower CPU utilization. Storage areanetworks (SANs) provide flexibility, but still require dedicated disks andheads/filers/controllers. Striping RAID groups vertically across heads scales better than



Network interface cards/switches

dedicating one or more entire disk arrays to a single head. SATA drives are notrecommended.

Page file spaceEnsure that page file space equals the greater of these values:

l # of concurrent users * 1MB RAM

l 2X Total RAM

Locate page file space on different physical disk drive(s) from those containing theathenaPractice database.

Optimize server memory usageWindowsServer operating systems have a setting for maximizing throughput. Refer toClient workstation software on page 13.WindowsServer includes a setting foroptimizing how Remote Desktop Services utilizes server memory andmaximizesthroughput for applications. This is set as part of the installation/upgrade process.

Network interface cards/switchesSystems and network cabling should be installed and configured by trained computerprofessionals. Plan to engage a network support specialist for installation and ongoingsupport.

Do not use Network Hub devices for network connectivity.

SwitchesFor maximum throughput, use 1000Base-T or greater switches.

Network cardDual-port 1 GB Ethernet (1000Base-T) network card. For optimal performance,configure network bandwidth between 1Gbps to 10Gbps.

WiringEthernet twisted pair CAT-5e or CAT-6 compliant wiring or better.

RDS/XenAppWhile the ICA/RDP protocol is highly compressed, make sure your network hassufficient bandwidth to carry the traffic your environment requires.

WindowsGigabit (1000Base-T) preferred.

Network protocolTCP/IP only.

Application serverThe application server is aWindows server or VM running JBoss that handles:



Application server software

l Application logic and tasks between the client workstation user interface and thedatabase server.

l Application web sites and client web services.

l Interop services that process data for Common Event Model (CEM) and FastHealthcare Interoperability Resources (FHIR) web services and business logic. Thisincludes subscription-basedmessaging, such asClinical Quality and FunctionalMeasure reporting and Immunization Registries, as well as access to FHIR API.

Depending on the number of concurrent users, separate servers can be configured tosupport each types of request to ensure optimal performance. Multiple servers with thesame role can also be configured for load distribution in larger implementations.

Server roles:

l Single server:Used for both client application processing (GUI) and Interopfeatures. This configuration is only recommended for sites with up to 100 licensedusers.

l GUI server:Used for application logic and client application processing, client webservices, and application web sites. This server is used with an Interop server forsites with over 100 concurrent users.

l Interop server: Processes data for Common Event Model (CEM) and FastHealthcare Interoperability Resources (FHIR) web services and business logic. Thisincludes subscription-basedmessaging, such asClinical Quality and FunctionalMeasure reporting and Immunization Registries, as well as access to FHIR API.Used in conjunction with one or more GUI servers for sites with 100+ concurrentusers.

l Apache load balancer (optional):Required when two or more GUI servers areinstalled to distribute the requests between theGUI Servers. This is recommendedfor larger systemswith over 200 concurrent users.

Application server softwareThis version of athenaPractice was tested with the following at the time of initial release.

Microsoft Windows OS for the application serverValidated versions:



Microsoft .NET FrameworkValidated versions:

l .NET 4.7.2 (installed with the product)

l .NET 4.8



Application server hardware

Service Layer (installed with the product)Validated versions:

l JBoss 7.1.6 with 64-bit OpenJDK 1.8.0.242

l JBossCore Services Apache HTTP Server 2.4.29 (load balancer)

Application server hardwareRefer to theCalculating Hardware Requirements for athenaPractice spreadsheet todetermine the RAM, IOPS, Network, CPUs/vCPUs, disk space, number of hosts andVMs needed to support these configurations.

Data Exchange serverA Data Exchange server hosts Data Transfer Station (DTS) and optionally otherapplications including Qvera Interface Engine (QIE) or Millbrook Interface Kit (MIK). Aqualified workstation can host the client with LinkLogic enabled for monitoring purposes.

Qvera Interface Engine (QIE) can run with DTS on a server classmachine in smallenvironments.

Data Exchange server softwareThis version of athenaPractice was tested with the following at the time of initial release:

Microsoft WindowsServer OS for Data Transfer Station and optionally Qvera InterfaceEngine

QIE can run on the same server or VM with DTS in small environments (75concurrent providers or less). Otherwise, QIE requires a dedicated server. SeeQvera documentation for server hardware/software requirements.



WindowsOS for Data Transfer Station or LinkLogic dedicated workstation

l Windows 10 Version 1809, 1903, and 1909

Network connection limits for LinkLogic workstationsWindowsworkstation operating systems can be limited to support a maximumof 10network resource connections into the workstation. Each interface / LinkLogic stationdeployed consumes one resource connection. (Socket interfaces are exempt.)

If you plan to usemultiple interfaceswithout sockets or more than six LinkLogic stations,Services recommends aWindowsServer operating system.



Data Exchange server hardware requirements

About Qvera Interface Engine (QIE)Qvera Interface Engine v2.0.43 is required for Quality Reporting with CQR and otherproduct integrations. It can run with DTS on a Data Exchange server in smallenvironments or on its own dedicated server.

About LinkLogic and Data Transfer Station (DTS)LinkLogic's HL7 interfaceswork with Data Transfer Station to exchange data exchangewith other systems. A client workstation with LinkLogic enabled can be used tomonitorandmanage themessage flow. Ideally, Data Transfer Station is installed on one or moreseparatemachines, and the LLOGIC folder (incoming and outgoing HL7messages) isshared on the network to be accessible tomultiple Data Transfer Stations.

Data Transfer Station (DTS) workswith LinkLogic to automate data exchange with othersystems through files and TCP/IP socket connections. One or more DTS can be used byclinics to automate data transfer operations and balance the transfer load. For bestresults, whenmultiple DTS are required, install each instance to a separate qualifiedworkstation or server.

SeeManaging Interfaceswith athenaPractice for HL7 interface specifications andimplementation details.

Data Exchange server hardware requirementsRefer to theCalculating Hardware Requirements for athenaPractice spreadsheet todetermine the disk space, RAM, and CPU requirements for your implementation.

Network: Gigabit (1000Base-T) preferred.

Network ProtocolTCP/IP only

InternetHigh-speed connection recommended.

High data transfer rate considerations for DTSTheData Transfer Stationmessage transaction rate (TPH) is influenced by the size ofthe database server DTS communicateswith. For a data exchange transfer rateexceeding 1800message transactions per hour, a Quad processor-based or higherserver with proper disk configuration is recommended tomaximize DTS performance.

Transactions per hour (TPH) measures patient-relatedmessages processed perhour. Tests were performedwith one patient-relatedmessage per import file. This isthe preferredmethod of data import. TPH rate is also influenced by other factors:



Client workstation

l Number and speed of database server processors

l Memory on the DTS and database server

l Network speed

l DTS hard disk drive speed and throughput

l Server disk drive speed and configuration (stripe or hardware RAID)

l Data Exchange (DTS) server throughput speed

Client workstationWorkstations are deployed to run the client application. The client running on theindividual workstation is also known as a thick client.

Client workstation softwareThis version of athenaPractice was tested with the following at the time of initial release.

Microsoft Windows OS for clients

Validated versions:

l Windows 10 Versions 1809, 1903, 1909

Other components

l Microsoft Internet Explorer 11 (32-bit) StandardMode (CompatibilityMode is nolonger supported)

l Chromium engine (for customHTML forms)

l Adobe Acrobat Reader is required to open PDF attachments. Reader can bedownloaded from the Adobe site.

ReportsCrystal® Reports Professional XI R2 by SAP BusinessObjects.

Reports included in the product are written in this version. Youmust use this version tomodify them.

Customized factory reports created in or converted to Crystal Reports v10.0 should openwithout issues in Crystal Reports Professional XI R2. Custom reports created in earlierversionsmay require additional steps to convert.

For more information about Crystal Reports and help with migrating older reports, go tohttp://www.sap.com/solutions/sapbusinessobjects/index.epx

Do not install Crystal Reports Professional XI R2 to a workstation where theclient is installed. The client application supports an optional integrated version ofCrystal Reports for custom business reporting. If you run a separate instance of



http://www.sap.com/solutions/sapbusinessobjects/index.epx

Incompatible products

Crystal Reports on the workstation, you will see an error each time you open theapplication.

Microsoft OfficeValidated versions:

l Microsoft Office 2016

l Desktop version of Office 365

FaxingBiscomFaxcom® v6.5.7 is the verified fax solution for Integrated Faxing. See alsoIntegrated Faxing.

For the latest detailed fax server requirements and configuration information, go tohttp://www.biscom.com.

Incompatible products

l Microsoft Edge andGoogle Chrome are not compatible with the product.

l Optical Character Recognition is not supported. However, you can scan documentsand store the acquired images directly to a patient chart. You can also annotate thescanned images.

Client workstation hardwareRefer to theCalculating Hardware Requirements for athenaPractice spreadsheet todetermine the disk space, RAM, and CPU requirements for your implementation.

Video cardScheduling workstations only. A video graphics card is required for workstations runningthe Schedulingmodule. The amount of videomemory required depends on acombination of factors that varies considerably from site to site:

l Resource (provider) columns displayed - this includes columns for canceled oroverbooked appointments.

l Time slots per day - shorter appointmentsmeanmore slots.

l Concurrent open instances of the schedulemodule - havingmultiple providerschedules open at the same timemultiplies total columns/slots.

l Running other third-party applications concurrently with this product on theworkstation.

Here are some estimates of video RAM required in different environments:

Simple configuration, moderateusage... Requires this RAM...

Fewer than 8 resource columns, 128 MB



http://www.biscom.com/

Remote Desktop Services/Citrix server/client

Simple configuration, moderateusage... Requires this RAM...

typically viewing one instance at atime.

Fewer than 8 resource columns,typically viewing several instances ata time.

256 MB (with 4 GB system RAM)

High-usage configurations require more RAM. Example: 50+ resourcecolumns, 48 10-min appointments per 8-hr day, displaying multipleschedule template instances.

4 concurrent instances (maximum) 512 MB

5 concurrent instances 1GB

7 concurrent instances 2 GB

Separate video graphics card required. Onworkstationswith “integrated” or“built-in” video graphics support, performancemay suffer because RAMavailable for video/graphics processing is shared with the operating system.

NetworkGigabit (1000Base-T) preferred

ProtocolTCP/IP only

Internet connectionHigh-speed connection recommended for accessingWeb-based Problem andMedication reference and downloading product updates and documentation.

ModemDSL/cable or other high-speed fax/modem

Modemsmay be needed for faxing or remote access by providers and other users notdirectly connected to the server.

Other hardwareFor printers, monitors, UPS, scanners, and other hardware options and requirements,see Server/workstation hardware for other software.

Remote Desktop Services/Citrix server/clientTerminal servers are deployed to servemultiple (thin) clients to terminals orworkstations.



Impact of network infrastructure

Thin client connectivity softwareUse a client compatible with your backend system. Use the client softwarerecommended/required for your virtualization environment.

Validated versions:

l CitrixWorkspace app 2008 (version 20)

l Microsoft RDP onWindows 10 Versions 1809, 1903, and 1909

Impact of network infrastructureTheRemote Desktop Services/Citrix XenApp environment is sensitive to network traffic.Your network infrastructure also influences how many concurrent users yourimplementation can support. When insufficient network bandwidth is available for theserver to handle requests by users, the server slows and becomes unstable. Themoreresources the server spends on re-transmission of user tasks, the fewer resources theserver has for new application processing.

Remote Desktop Services/Citrix server softwareThis version of athenaPractice was tested with the following software at the time of initialrelease.

CitrixValidated versions:

l Citrix XenApp and XenDesktop 7.15 LTSR

ll Citrix Virtual Apps and Desktops 1909, 1912 LTSR

On the following operating systems:



Microsoft Windows Remote Desktop Services environment



Connection load balancingConnection load balancing is only available in Citrix; it is not available inWindowsRemote Desktop Services running RDP, where connection load balancing is handledoutside Remote Desktop Services.

Remote Desktop Services/Citrix server hardwareRefer to theCalculating Hardware Requirements for athenaPractice spreadsheet todetermine hardware requirements in a Remote Desktop Services/Citrix XenApp



Unsupported configurations/features in RDS/Citrix

environment.

ProcessorChoose the fastest processor within your budget that is not less than the recommendedvalue. CPU selection is based on the number of concurrent users.

Optimize server memory usageServer memory usage is optimized as part of the installation.

Page file sizeApplication Server RAM size X 2

NetworkGigabit (1000Base-T) preferred.

Improve performance and reliabilityDisk arrays: SAS, ISCSI, or Fibre Channel RAID 1 disk arrays increase diskperformance and reliability and lower CPU utilization.

Hardware level RAID 1 (disk mirroring):RAID 1 provides fault tolerance andperformance. If a hard drive fails, the server keeps running. The drive can be replacedwithout having to rebuild the server.

Reduce overheadA software RAID configuration requires the operating system to keep track of the raidconfiguration, creating overhead. Using a hardware RAID configuration, the operatingsystem sees drives in the array as one drive. All the RAID processing is independent ofthe Remote Desktop Services/Citrix XenApp operating system.

Unsupported configurations/features in RDS/CitrixThe following configurations and application features are either not supported in aRemote Desktop Services/Citrix environment or require additional steps or workaroundsto use

l Hosting the application via Terminal Services/Citrix on the dedicated Databaseserver.

l Installing and running the demo (training) database of athenaPractice on the RemoteDesktop Services/Citrix server. Instead, install and run on a supported thick client orserver classworkstation. See Client workstation software.

l Data Transfer Station (DTS), Encounter FormEditor, Formulary Editor. Run theseapplications on a server or a thick client.

l Runningmultiple versions of athenaPractice on a single server.

C-Now web browsersC-Now is a new cloud-based application that allows providers to log in using a webbrowser on any device and access appointments and patient data from your



Third-party integration server hardware and software

athenaPractice solution. For more information, see the C-Now User Guide.

Validated web browsers

l Chrome

l Edge

l Firefox

Limited functionality is available on Safari and Internet Explorer.

Third-party integration server hardware and softwareIntegration products, such as ePrescribing, securemessaging, patient portals, anddocument scanning require a dedicated server.

Refer to the documentation for your integration product for hardwarespecifications for a dedicated server and other configuration instructions.

Important. All Surescripts Enterprise Services serversmust be TLS 1.2compliant.

ePrescribing with Surescripts eScript Messenger (eSM)Surescripts eScript Messenger requires a dedicated server or VM. This version ofathenaPractice requires eSM v4.4.3 or higher.

Note: The use of eSM is dependent on Surescripts translation services, which has anexpiration date of September 1, 2021. If you electronically prescribemedications throughathenaPractice, youmust activate the new MedicationManagement module before theSurescripts translation services expiration. See the Release Notes for more information.

Clinical Messaging - Secure Messenger Patient PortalClinical Messenger requires Surescripts SecureMessaging Patient Portal (SMPP) ona dedicated server or VM. This version of athenaPractice requiresSMPP v8.0.16 orhigher.

For detailed requirements, see https://support.surescripts.com/

Depending on clinic size and security requirements, SMPP can have twoservers -- one application server and one web server.

Document ManagerDocument Manager for document scanning requires Surescripts Document Manageron a dedicated server or VM. This version of athenaPractice was tested with DocumentManager v9.2.1 at the time of initial release.



https://centricity.athenahealth.com/s/hcd-librarypage?Id=0686f000007G9hr

https://support.surescripts.com/

Server/workstation hardware for third-party software

Depending on clinic size and security requirements, SMPP and DM canshare a server.

Electronic Medication Prior Authorization (EMPA)This version of athenaPractice™ was tested with EMPA v4.3.1 at the time of initialrelease.

Automated Clinical Messaging (ACM)This version of athenaPractice was tested with ACM v4.0.4 at the time of initial release.

Imprivata (identity proofing for EPCS and SFA)Imprivata Confirm ID is required for both Electronic Prescribing of ControlledSubstances (EPCS) and Single Factor Authentication (SFA) for prescribing if you areusing eSM. However, it cannot be used with the new MedicationManagement module.SeeMedicationManagement MaintenanceGuide for identity proofing requirements withMedicationManagement.

This product supports versions starting with Confirm ID 5.4; however, if you are followingthe Individual identity proofingmodel, theminimum version requirement is 6.0. If newlyinstalling, best practice recommendation is to proceed with the latest release, which atthe time of initial release is Confirm ID 7.0. Your assigned Implementation Consultantcan provide information on the version you will be deploying.

Other patient portals

l ezAccess v4.0.328+For details, go to https://www.ezaccessmot.com

l Medfusion v17.2.1+For details, go to https://www.medfusion.com/contact/client-support/

Qvera Interface Engine (QIE)This version of athenaPractice was tested with QIE v2.0.43 at the time of initial release.

Server/workstation hardware for third-party softwareA separate server is required for applications other than athenaPractice, such as email,workgroup applications, and unrelated file and print services.

Do not use the dedicated database server for third-party software activity.

MonitorsColor SVGA Display: Minimum resolution 1024 x 768 - Small Fonts, High Color (16-bit,65536 colors) or greater.

Higher resolution is required for image capture, viewing, and annotation.



https://www.ezaccessmot.com/

https://www.medfusion.com/contact/client-support/

Server/workstation hardware for third-party software

If you are using high resolutionmonitors, review and find appropriate settings that bestsuit your display. For more information, see: https://support.microsoft.com/en-us/help/4026956/windows-10-change-screen-resolution.

Uninterruptible power supply (UPS)To avoid data corruption during power brownouts, connect the Application server, theData Exchange server, and the Database Server, and concentrators to a UPS with atleast 15minutes of full load backup power.

Set the UPS to shut down the server automatically after a specified period. During anextended power outage, this gives users time to log out before the server shuts down.

l Servers: Minimum15minutes emergency full load backup power

l Workstations: Recommended 5minutes emergency full load backup power

l Data Exchange server/DTS: Power management software recommended to shutdown the DTS safely in the case of an extended power failure.

Printers

Recommended RequiredMid-range laser printers. Some reportsrequire laser printers. The application hasbeen tested on mid-range laser printers.Some low-end printers do not have a largeenough printable area.

Microsoft Windows Server-based printing

Dot-matrix printers. For printing forms withcarbons.

Additional printers will be requireddepending on the size andrequirements of theclinic/enterprise. Printer locationsshould support workflow plans.

Application printable area limitsPrinting functions are supported on any printer capable of handling a printable area of 8inches by 10.6 inches on letter-sized paper.

Crystal Reports printable area limitsTheCrystal Reports driver used in the product supports pagemargins of 0.17 inches top,0.25 inches left / right sides, and 0.23 inches bottom for letter paper size by default.

Photo ID and image captureAny TWAIN-compliant digital video device, digital camera, or scanner that plugs into aUSB port is supported. The application captures still images directly from the device in.BMP or .JPG formats. Images can also be acquired from file system image files, or bycopying and pasting from another application.

See also Storing images.



https://support.microsoft.com/en-us/help/4026956/windows-10-change-screen-resolution

https://support.microsoft.com/en-us/help/4026956/windows-10-change-screen-resolution

Integrated Faxing (Chart)

For best results, test image capture solutionswith the application prior topurchase.Webcam devicesmust be compatible with your operating system.And, depending on your device, additional setup is required to use a webcam.

Media Drive16x-speed or faster DVD drive

Required on the Remote Desktop Services/Citrix server to install the server operatingsystem.

ModemModemDSL/cable or other high-speed fax/modem

Modemsmay be needed for faxing or remote access by providers and other users notdirectly connected to the server.

Backup systemTape drive for backups or backup system from another server with access to theDatabase server, Remote Desktop Services/Citrix server, Application server, or DataExchange server.

Backups are recommended after installing or upgrading to facilitate quick recovery ifhardware problems occur or disk drive data is lost.

If for any reason you require Services assistance in restoring your database frombackup, youmust have a SQL .bak file. If you do not have a SQL .bak file, we willnot be able to assist you in restoring your database.

Surge protectionPower surge protector for eachmachine to protect against voltage variations.

OtherAC power, network, keyboard, and display extension cablesmay be required for optimalworkstation placement.

Integrated Faxing (Chart)Biscom's FAXCOM® fax solution is verified with athenaPractice. Integrated Faxingpermits users to fax prescriptions and other information directly from charts.

Note: WhenMedicationManagement is activated, prescriptions are faxed viaMedicationManagement functionality instead of FAXCOM. Other chart documents, suchas chart summaries, can still be faxed through FAXCOMwhenMedicationManagementis activated.

For more information about FAXCOM, go to https://www.biscom.com/fax-for-ge-centricity-ehr/.



https://www.biscom.com/fax-for-ge-centricity-ehr/

https://www.biscom.com/fax-for-ge-centricity-ehr/

Important features and system settings

For detailed installation instructions, contact your Biscom representative. To configureIntegrated Faxing, see information in the online help (pressF1 on theAdministration >System > Faxing screen).Operating systemIntegrated Faxing runs in Citrix/Remote Desktop Services environments.

Tested software version

l FAXCOMCV 6.5.7.0

To use Integrated Faxing, install at least one BiscomFAXCOM® fax server on yournetwork in a secure environment.

Hardware requirementsFor detailed hardware requirements, contact your Biscom representative.

If your clinics are geographically distant or located inmore than one state, consider aleast-cost routing configuration, which will require more than one fax server. For moreinformation about least-cost routing and fax server configurations, go to the Fax Solutionpage at https://www.biscom.com/whitepapers-datasheets/.

Important features and system settingsThe following features and system settings impact memory requirements and systemperformance.

Enabling Chart clinical auditing featuresEnabling all available auditing features significantly increases database storage andgrowth requirements, possibly by a factor of 2 or greater. Consult Services or yourValue-Added Reseller when enabling auditing features.

Storing imagesAvoid storing images in the product database. Add image attachments to a chartdocument and store them in the Document Management server database, including stillimages from a digital camera or video camera or scanned documents images.

Disk space for images varies considerably. Refer to theCalculating HardwareRequirements for athenaPractice spreadsheet to calculate your organization’srequirements.

Getting technical supportIf you require help, contact your Value Added Reseller or Services at 888-436-8491 oronline via the athenaFlexCustomer PortalCases page.



https://www.biscom.com/whitepapers-datasheets/

https://athenaflex.athenahealth.com/

Getting technical support

Register to access the athenaFlex Customer Portal

1. Go to the athenaFlexCustomer Portal main page and clickRegister For AnAccount.

2. Fill out the registration form, including all required fields (*).3. Check one or more products in the list. (Select the product(s) you have licensed. At

least one is required.)

4. ClickRegister to request access.You will receive an activation email approximately 24-48 hours later with instructionsfor logging in. Your user namewill be the email address you chose when registering.

If you have questions or difficulty completing registration, contact Customer Serviceat 888-436-8491.

Join online communitiesYou can join online communities related to your product and features and view the latestcommunications, product postings, and other implementation resources.

1. Log in to the athenaFlexCustomer Portal for your product, and then clickCommunity.

2. Under Resources, selectAvailable Communities.3. Select Join for communication threads you want to follow. SelectUnjoin to stop

following. You’ll receive a weekly digest email update when new items are posted toa community you joined.

4. To change how often to receive email updates, visit each joined community and clicktheWeekly Digest email icon the upper right corner. Then select a frequency:Weekly Digest (default), Daily Digest, Every Post, or Limited.

5. To view the latest communications, log in and look underRecent Content or selecta community name.



https://athenaflex.athenahealth.com/s/

Documents

ConfiguringEnvironmentsfor athenaPractice™v20...TableofContents ConfiguringEnvironmentsforathenaPractice™v20 1 Hardwareandsoftwareplanningconsiderations 1 Upgradeoptions 1 Implementationscenariosbyclinicsize