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Sage Intergy 6.10 Architecture Guide

Sage Intergy 6.10 Architecture GuideReference

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Table of Contents

Sage Intergy 6.10 Architecture Guide . . . . . . . . . . . . . . . . . . . 1How to use this document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Abstract Application Workflow . . . . . . . . . . . . . . . . . . . . . . . 2Sage Intergy Desktop . . . . . . . . . . . . . . . . . . . . . . . . . 2Sage Intergy EHR Client . . . . . . . . . . . . . . . . . . . . . . . 3

Scalability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Physical Application Workflow . . . . . . . . . . . . . . . . . . . . . . . 4Client Connectivity Options . . . . . . . . . . . . . . . . . . . . . . . . . 5

Standard Sage Intergy Client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Sage Intergy Terminal Services Client . . . . . . . . . . . . . . . . . . . . . . . 5Sage Intergy EHR Clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Peripheral Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Standard Server Installation Options . . . . . . . . . . . . . . . . . . . . 7Sage Intergy Imaging Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Sage Intergy Terminal Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Sage Practice Analytics Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Standalone AppServer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Virtual Server Installation Architecture . . . . . . . . . . . . . . . . . . 9Software Compatibility and System Requirements . . . . . . . . . . . . . . . 9Virtual Server Best Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Virtualization Performance Considerations . . . . . . . . . . . . . . . . . . . . 10

Sage Intergy Service Options . . . . . . . . . . . . . . . . . . . . . . . 12Stand Alone Remote Print Server . . . . . . . . . . . . . . . . . . . . . . . . . . 12Report Server for WAN clients . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Stand Alone Medcin Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Standalone Document Delivery Server . . . . . . . . . . . . . . . . . . . . . . 13Practice Portal Broker Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Sage Sage Intergy 6.10 Architecture Guide i



Sage Intergy is the premier practice management software for medical offices of all sizes. A

powerful database and an intuitive user interface are combined to increase the efficiency of

daily health care services. When implemented in a medical computing environment, Sage

Intergy 6.10 may be installed in many different configurations.

Some installations use only one server and a small number of simple client workstations.

Other installations use several servers, and many different types of client workstations

distributed over a wide geographic area. This document describes the different

configurations of Sage Intergy and how each component is connected.

This document is intended for use by Sage customers to determine what hardware and

software is needed to implement or upgrade Sage Intergy 6.10 in their computing

environment. As always, the components and services in this document are subject to further

revision based on individual customer site requirements.

How to use this document

A Sage Intergy environment may be composed of many interconnected components, and not

all systems and peripherals described in this document may be in use in your environment.

Sage customers and Sage technicians should use this document to determine how best to

install or upgrade a Sage Intergy implementation. Carefully consider the requirements and

needs of the Sage customer site, and evaluate the costs and benefits of installing specific

components.

Sage Sage Intergy 6.10 Architecture Guide 1


Abstract Application Workflow

The following components are present in a standard implementation of the Sage Intergy

application:

• Sage Intergy Client

• Sage Intergy EHR Client

• AppServer

• Java Dispatch Framework (JDF)

• Progress Database

• Imaging

Understanding how these components are installed will help Sage customers and Sage

technicians determine the number and types of server devices that must be installed.

Like all client/server applications, the Sage Intergy client and the Sage Intergy database

server components operate as separate programs. In general, the client program does not

perform database operations directly, and the server programs do not provide a user

interface or other interactive services.

Both the client and the server may be further divided into separate components.

Operation of client programs for the Sage Intergy desktop and the Sage Intergy EHR client is

slightly different. This application workflow follows these numbered steps:

Sage Intergy Desktop

1. The Sage Intergy client application initiates a connection to the AppServer.

2. The AppServer processes client requests for data and routes them to the Sage Intergy

database as required.

3. The Sage Intergy database responds to queries and returns data to the AppServer, which

delivers this response back to the Sage Intergy client. For some functions, a direct

connection between the Sage Intergy client and database may now be established.

2 Sage Intergy 6.10 Architecture Guide Sage


4. The Imaging system responds to queries and returns the location of a binary file to the

Sage Intergy client. The Sage Intergy client then retrieves the binary file using this

response and processes it for display.

Sage Intergy EHR Client

1. The Sage Intergy EHR client application initiates a connection to the Java Dispatch

Framework (JDF).

2. The JDF initiates a connection to the AppServer.

3. The AppServer processes client requests for data and routes them to the Sage Intergy

database as required.

4. The Sage Intergy database responds to queries and returns data to the AppServer, which

delivers this response back to the JDF and the Sage Intergy EHR client.

5. The Imaging system responds to queries and returns the location of a binary file to the

Sage Intergy EHR client. The Sage Intergy EHR client then retrieves the binary file using

this response and processes it for display.

Note that for both types of clients, after authentication and requests have occurred through

the AppServer, client programs may access the Sage Intergy database and the Imaging

system directly.

Scalability

The Sage Intergy system is scalable and can support a medical computing environment of

almost any size. Some Sage Intergy installations support only one doctor with one medical

practice. Slightly larger systems may support a single practice with multiple doctors. The

largest systems may accommodate multiple practices, each with several doctors.

In the smallest Sage Intergy systems, all server components are consolidated onto one server

device for the most cost-effective solution. As Sage Intergy installations grow, some of the

functions of the Sage Intergy server may be installed on other servers to meet the

performance and storage needs of a site with more patients to see and more records to track.

Installing these components on separate servers may be required for sites with specific

computing requirements as well. For example, Sage customer sites with radiology functions

may require the Document Delivery Server (DDS) system to be installed on a separate server.

In customer sites where more than 350 users will be connected at the same time, multiple

AppServer components may be installed on several servers. This type of server is known as a

Standalone AppServer, and is installed to distribute client application requests over several

servers to maximize database performance. When Standalone AppServer devices are

installed, the Sage Intergy installation is described as an N-tier environment, due to the

multiple tiers of servers that are present.



Physical Application Workflow

In a typical Sage Intergy implementation, client components are installed on Windows

desktop workstations and all server components are installed on a single server device.

However, in N-tier environments each stand alone AppServer device will have its own

appserver and JDF process installed. Typically, only one database server is installed in any

Sage Intergy environment, no matter how many appservers are implemented.

All Sage Intergy application functions use TCP/IP network connectivity for client/server

connections and any database query activity. This is true whether or not the appserver and

the database are installed on the same hardware. Refer to the following chart for information

on the network ports required for connectivity between different Sage Intergy services and

applications. Note that all listed values are TCP port numbers unless otherwise specified.

Note also the following TCP port usage for Internet connections:

• Practice Portal uses TCP port 2443 and initiates a connection between the Sage Intergy

database server and a server on the Internet.

• Eligibility verification application services use TCP port 6861 and 6881 and initiate a

connection between a Sage Intergy client workstation and a server on the Internet.

When installing a new Sage Intergy site, or when troubleshooting an existing one, TCP and

UDP network connectivity should be evaluated to determine if specific services or application

functions are blocked. TCP/IP port blocking or filtering between different LAN switches or

VLAN segments may affect the functionality of distributed Sage Intergy application functions.

Table 1: Network port connectivity for Sage Intergy application functions

Sage

Intergy

Client

Sage

Intergy

EHR

Client

Appserver JDFProgress

DatabaseImaging

Progress

Nameserver

Sage Intergy

Client

N/A N/A 3070, 3080,

3081, 3082,

12000-15000

N/A 2500-2504,

15001-

17000

10001 5162 (UDP)

Sage Intergy

EHR Client

N/A N/A N/A 60001,

60004

N/A 10001 N/A

Appserver

3070, 3080,

3081, 3082,

12000-

15000

N/A N/A 12000-

15000

2500-2504,

15001-

17000

N/A N/A

JDF N/A 60001,

60004

12000-15000 N/A N/A N/A N/A

Progress

Database2500-2504,

15001-

17000

N/A 2500-2504,

15001-17000

N/A N/A N/A N/A

Imaging 10001 10001 N/A N/A N/A N/A N/A

Progress

Nameserver

5162 (UDP) N/A N/A N/A N/A N/A N/A



Client Connectivity Options

In any Sage Intergy implementation, many different client components can be installed using

several different hardware configurations. Some implementations require specialized

hardware, network connectivity, or additional third-party components to be installed. The

various possible client installation for Sage Intergy is described in this section.

For Sage Intergy versions 3.50 and higher, the following client configuration options are

available:

Standard Sage Intergy Client

Most Sage Intergy installations will include standard Sage Intergy client workstations. These

workstations are desktop computers that are located on the same local area network (LAN)

as the Sage Intergy database server and can have the full client application installed on the

local hard drive. This type of client workstation also typically includes the Sage Intergy EHR

client program. Some environments that do not use Sage Intergy EHR functions may not

have the Sage Intergy EHR client installed.

Sage Intergy Terminal Services Client

To support the operation of thin clients and hosted solutions, workstations that operate the

Microsoft Remote Desktop Client (RDC) program may access a published desktop that

includes Sage Intergy client components. In the case of the Sage Intergy Appliance, Sage

Intergy On Demand (IOD), or Sage Intergy 6.00 and higher, a Terminal Services client is

available as a default connection option. This type of workstation may be connected to the

same LAN as the Sage Intergy database server, or to the public Internet in the case of IOD.

Terminal Services client computers have system requirements that differ from the standard

Sage Intergy client workstation. Refer to the Sage Intergy system requirements document for

the version that you are installing.



Sage Intergy EHR Clients

The Sage Intergy EHR client program is separate from the Sage Intergy client application.

This application is installed separate to support clinical functions only, for users who may not

require the other functions of the main Sage Intergy client.

In some cases, Sage Intergy EHR client computers may be installed outside of the customer

computing environment. Usually, this will be a computer in another office that is connected to

the Internet. This type of workstation is known as a Sage Intergy EHR WAN Client. One

possible implementation of this type of workstation is the installation of the Sage Intergy EHR

client program on a physician’s home computer.

Sage Intergy EHR client applications are also available for compatible portable computing

devices. A Sage Intergy EHR Tablet device operates the full Sage Intergy EHR client on a

computer with a touch screen and special input devices. The Sage Intergy EHR PDA is a

Windows CE or Windows Mobile device that allows specific clinical functions in a handheld

form factor. Portable computing devices used with Sage Intergy EHR may be installed on the

same LAN as the Sage Intergy database server, or may be connected to the public Internet

instead.

When Sage Intergy EHR client devices are connected to the public Internet for WAN

connectivity, additional registration with the Sage Remote Management System (RMS) is

required for security and authorization.

Some customer environments are known as Sage Intergy EHR Administration or Stand Alone

Sage Intergy EHR installations. This is when the EHR clinical records product is installed to

support a different practice management system other than Sage Intergy. In these cases,

client computers will have only the Sage Intergy EHR client program installed. Typically, these

workstations are installed on the same LAN as the Sage Intergy database server.

Peripheral Devices

Most Sage Intergy implementations will include scanners and printers. Scanning devices are

used to record external documents into the imaging system. Printers are used for reporting

purposes, to print receipts and labels, and to provide other hardcopy output. In a standard

installation of Sage Intergy, scanners are connected directly to workstation computers using

TWAIN drivers, and printers are installed as network devices.

Note that when installing scanners in an environment where Terminal Services is

implemented, additional software is required to support correct operation. Sage has certified

the Remote Scan product as the approved program for imaging functions where a scanner is

installed on a Sage Intergy Terminal Services client.

When installing a printer in a Terminal Services environment, a default printer must be defined

in the host operating system of the client computer. The Remote Desktop session defined for

each Terminal Services client is already configured to print to the default printer. In some

cases, additional printer drivers may need to be installed on the Sage Intergy database server

or the Terminal Server to support some printer functions.



Standard Server Installation Options

Many Sage Intergy implementations will include multiple servers. Depending on the original

version that was installed, and the number of users that must be supported, it may be

necessary to split some core functions of the Sage Intergy database server into separate

devices.

This section describes the standard options available for all installations of Sage Intergy when

more than one server is required. For a description of separate servers for Sage Intergy

services, refer to the Sage Intergy Service Options section beginning on page 9.

Sage Intergy Imaging Server

By default, the Sage Intergy Storage Server (ISS) is installed directly on the Sage Intergy

database server. This program is a separate database product used for storage of images

and other large binary data associated with practice management and clinical records.

To accommodate specific implementation requirements, ISS may be installed on a separate

server. Also, in Sage Intergy versions 5.50 and older, the FileX imaging server product may be

installed instead.

Connectivity between the Sage Intergy client and a separate Imaging server must be

configured using the Sage Intergy System Administration tool. Note that a separate Imaging

server device must be located on the same local area network (LAN) as the Sage Intergy

database server. As a best practice, both devices should operate on the same network

segment.

Sage Intergy Terminal Server

For Sage Intergy 6.00 and higher, Microsoft Windows Terminal Services is installed by default

on the Sage Intergy database server. However, this configuration does not support more than

forty concurrent Remote Desktop connections. For customer sites where more than forty



terminal services clients must be installed, or where Sage Intergy 5.50 or older is installed, a

separate Terminal Server is required.

Sage Practice Analytics Server

In a typical installation, Sage Intergy 6.10 and higher includes a separate server to operate

Sage Practice Analytics. By default, all new installations of Sage Intergy 6.10 include Sage

Practice Analytics Quality Measures Edition (QME) to support the meaningful use functions of

the EHR product. When purchased separately, the full edition of Sage Practice Analytics is

also deployed on a separate server to replace the QME edition of the product.

In any configuration, Sage Practice Analytics operates a Microsoft SQL Server database and

a requires a separate client application for operation. This database may not be installed on

any server that is already operating a Sage Intergy program component.

Standalone AppServer

In a typical installation, a Sage Intergy database server may support up to 350 standard

clients. This limitation applies to all versions of Sage Intergy. To accommodate connections

from a number of clients greater than 350, additional AppServer application components

must be deployed in the customer site on separate hardware. These AppServer components

are intended to manage large numbers of client connection requests and distribute the load

of database queries across multiple servers. This type of Sage Intergy implementation is

known as an N-tier installation.

Standalone AppServer devices require special configuration and database parameter

settings for effective load balancing of client connections.



Virtual Server Installation Architecture

For Sage Intergy 6.00 and higher, one or more Sage Intergy server components may be

installed as on a virtual server. In this type of configuration, virtual servers are said to be guest

systems that operate as software only, and are executed on a physical server known as the

host system.

In a virtual server implementation, hardware components such as the CPU, memory, and

network interface are emulated in software. The advantages of implementing a virtual server

are the ability to operate multiple virtual servers on a single host device, and the ability to

move a virtual server to a backup device or to another host system. Depending on the type of

host system that has been implemented, it may be possible to use advanced load-balancing

and system tools to manage the operation and reliability of the virtual server in ways that are

not possible with physical hardware. However, the performance of a virtual server generally

requires more storage, CPU, and memory capacity in the host system than would be required

for a single physical machine. These capabilities and restrictions are described in detail in this

section.

Software Compatibility and System Requirements

Sage Research and Development has tested and certified the use of VMWare ESX versions

3.x and 4.x for use with Sage Intergy 6.00 and higher. When implementing a virtual server for

use as any part of a Sage Intergy environment, the CPU, memory, storage, and other virtual

components must match or exceed the system requirements required for the same type of

physical server device.

Refer to the Sage Intergy 6.10 System Requirements document for detailed information on

the specifications needed for physical Sage Intergy server components, and for specific

information on configuration requirements for virtual servers.



Virtual Server Best Practices

Implementation of a virtual server to operate any portion of a Sage Intergy installation

requires a configuration that matches or exceeds the specifications for a physical server, as

specified in the Sage Intergy system requirements. CPU resource usage and network

communication capabilities must be unrestrained and not subject to any restrictions that

would not also be present in a physical server device.

In addition to the specific configuration requirements stated in the system requirements

document, some management and operation functions of a virtual server environment may

not be used when Sage Intergy is installed. Do not employ the following management

practices for Sage Intergy virtual servers:

• Live Migration - When more than one host machine is available in the same virtual server

environment, the VMWare product allows a virtual server to be moved to a different host

machine. However, as a best practice, Sage Intergy systems should be shut down before

they are migrated to prevent data corruption or other damage to database files. Do not

use the pause feature of any virtualization product, or allow a virtual server to be migrated

while it is still running.

• Host System Sharing - As a best practice, isolate a virtual server that is running Sage

Intergy so that it is the only guest system on any one host server. Installation of multiple

virtual servers on a single host may affect the performance of the virtual disk and network

functions of the Sage Intergy system. Whenever possible, operate a virtual server with

Sage Intergy on only one host system.

Virtualization Performance Considerations

Sage R&D System Engineering personnel have conducted testing on Sage Intergy virtual

servers to compare their performance with comparable physical hardware. Sage engineers

found that when configured with comparable specifications, virtual servers and physical

servers provided an equivalent user experience when using Sage Intergy. However, the

management and portability advantages of a virtual server are offset by performance

disadvantages.



As one example, system engineers compared the disk I/O performance of a virtual server and

a physical server with comparable configurations.

The results of this testing showed that on average, disk performance for both read and write

operations was slower by ten percent for virtual servers as compared to a physical server.

System engineers performed tests for other system performance metrics, such as network

response, that showed a similar performance disadvantage for each server function.

When evaluating the implementation of a virtual server host system, Sage technicians and

Sage customers should weigh the advantages of manageability and portability against the

cost of installing host hardware that will provide sufficient performance for any new or

upgraded Sage Intergy system. Although daily operation of the Sage Intergy client is not likely

to be affected, some operations that require large input and output capacity may be

impacted when used on a virtual server. These impacted operations may include long

reports, database maintenance functions, or external connectivity from applications such as

Sage Practice Analytics.



Sage Intergy Service Options

Although most Sage Intergy services will be installed on the database server, in some cases

these services may be installed on separate hardware. This section describes the

circumstances under which these types of services may be implemented on a stand alone

server.

Stand Alone Remote Print Server

The purpose of a Sage Intergy Remote Print Server (RPS) is to manage large Sage Intergy

reports and send them to a designated system printer. This reduces workload on Sage

Intergy Client PC's, by permitting large Sage Intergy reports to be offloaded from the Sage

Intergy Client PC so that the user's workflow is not interrupted.The Remote Print Server only

affects reports that are sent directly to a Sage Intergy system printer managed by a Remote

Print Server. Simply viewing a Sage Intergy report on the screen will not utilize the Remote

Print Server.

In most cases, an RPS is not required. It should only be considered in unique situations after

conducting performance analysis if so warranted as determined by client’s printing volume

and workflow requirements, for example.

Clients using Sage Intergy EHR PDA require a Remote Print Server running on the Sage

Intergy Database Server but not necessarily as a dedicated standalone server. Sage IEHR

installations that include PDA clients make use of the RPS server for prescriptions and other

specialized printing functions. Make sure all Sage IEHR PDA environments include a Remote

Print server.

Report Server for WAN clients

A report server is an application used only with configurations that include WAN clients. It

builds and compresses a report before sending it to a WAN client. The compressed report

data is sent back to the WAN client where it is uncompressed and processed.

This reduces network traffic, because the report server communicates with the database

server over the LAN to obtain the data to build the report. For configurations with WAN



clients, a dedicated report server is not required. One report server is already installed by

default on the database server.

The network connection between the database server and the report server must be a LAN

connection to fully realize the benefits of this type of configuration.

If the client does not have a MS Windows Domain Controller (DC), the Sage Intergy Report

Server can be upgraded to function as the client’s DC.

Stand Alone Medcin Server

The Medcin server has a database that contains a rich knowledgebase of diagnosis and

procedure codes and terminology needed by a provider for evaluation of patient care. The

Medcin server provides formatting of an encounter note narrative in plain text, RTF or HTML.

When a client/server session is established, the server maintains state information for the

client. The state information for a session can be maintained between connections. State

information may include the patient’s demographics, complete medical history, and search or

prompt functions in progress.

The Medcin server may be installed to server hardware or to a client workstation. Sites that

cannot upgrade the Sage Intergy database server’s CPU or memory may experience

sustained excessive CPU usage or paging, causing unacceptable performance. Customers

who observe this type of issue should consider adding a standalone Medcin server.

The Medcin server may also run on a computer running the Remote Print Server, Standalone

AppServer, Document Delivery Server, or Report Server modules.

Standalone Document Delivery Server

The Document Delivery Server processes approved transcriptions and prints and/or faxes the

documents to the associated referring physicians. The Document Delivery Server uses third-

party software and hardware to fax transcriptions.

The Transcription Writer and MS Word 2003 or later are prerequisite components on the

machine that has the Document Delivery Server for processing inbound and outbound

transcriptions via HL7.

The Document Delivery Server is currently only utilized for radiology sites, or for sites using

clinical correspondence and background approval functions of the encounter notes.

The Document Delivery Server may run on a stand alone application server or a client

workstation. Sites that cannot upgrade the Sage Intergy database server’s CPU or memory,



and are experiencing sustained excessive CPU usage or paging, causing unacceptable

performance should consider adding a standalone Document Delivery Server.

The Document Delivery Server may also run on a computer running the Remote Print Server,

Standalone AppServer, Medcin Server, or Report Server modules.

Whenever possible, it is preferable to upgrade the Sage Intergy database server and install

the Document Delivery Server on the same hardware. This is generally a more cost-effective

solution, and is less complicated to configure.

Practice Portal Broker Server

The Practice Portal broker manages communications between the practice and remote

services hosting the patients’ web-based user interfaces. As the patient navigates through

various web pages, clinical and demographic information is supplied through the broker.

The Practice Portal broker may be installed on either the Sage Intergy database server or on

a separate stand alone application server. Before choosing how the broker will be installed,

consider the computing environment requirements:

• 24x7 availability - Since the portal will not be available to patients during any sever

downtime, the Practice Portal broker requires a high-availability server. Note that items

that might affect server availability include hardware/OS stability and the maintenance

requirements of other applications running concurrently on the server.

• Communications server connected to a public network (i.e., Internet) - While great

effort has been taken to insure broker security, some customer environments may require

that sensitive data like the Sage Intergy database is not also located on the server where

the Practice Portal broker is installed. In these instances technicians may be directed to

exercise the option of installing Practice Portal on a separate server.

NOTE: When accessing the Practice Portal website on either a client workstation or a

patient’s home computer, the website can be viewed on IE 6.0 or higher. The website can

be viewed on Mozilla Firefox 2.0 and later as well.

• Internet Connection Speed - To accommodate connections to the web server from the

Internet, a minimum upload speed of 720 kB/sec is required for the Practice Portal server

Internet connection.


Documents

Sage Intergy 6.10 Architecture Guide - · PDF file4301 West Boy Scout Boulevard, Suite 800 Tampa, FL 33607-9953 Phone: 877-932-6301 . Sage Sage Intergy 6.10 Architecture Guide i Table