We are all very poor at predicting the future. Consider Tim Berners-Lee,* the inventor of the World Wide Web, who had no idea of what would become of his innovation. No one would have predicted that pharmacy practice, like so much of our personal and profes- sional lives, now uses the Web. Likewise, Thomas Watson, president of IBM, said in 1943, “I think there is a world market for maybe five computers.” All of this is nicely summed up in
The Next Fifty Years. Science in the First Half of the Twenty-First Century,1 where a number
of major contributors to science and technology do a great job of predicting what might be, but rarely venture beyond 5 years and certainly not 50.
I said that we cannot reliably predict the future of information technology; however, success in pharmacy informatics may require doing so in ways that range from the
* Most pharmacy students have no idea who invented the Web, which speaks to the ubiquitous nature of how tech- nology is perceived. There is a brief “wow” moment, followed by immediate acceptance and a hankering after the next new innovation.
purchase of a new laptop computer to making decisions about the hardware and soft- ware needed to support a major pharmacy chain. How should this apparent dilemma be approached?
A useful way would be to examine data that represent trends from the past that can be projected into the future. Perhaps the most well known trend in information technology is attributed to Gordon Moore and is known as Moore’s law (http://en.wikipedia.org/wiki/ Moores_law), which states, “Since the invention of the integrated circuit in 1958, the num- ber of transistors that can be placed inexpensively on an integrated circuit has increased exponentially, doubling approximately every two years.” Simply stated, if a new computer is bought every 2 years, the new one can be expected to be twice as powerful as the one bought previously.
This trend is expected to continue. It is hard to predict for how long, but this is perhaps one of the major features that defines how information technology does and will have an impact on the healthcare industry. Similar trends can be seen in disk storage, display tech- nology, network speed, etc. Accompanying speed, storage capacity, and screen quality are smaller footprints that can change our habits, moving us away from desktops to increas- ingly sophisticated handheld devices, with names like personal digital assistants (PDAs) and smart phones as exemplified by Apple’s iPhone (see Chapter 13).
3.2.1 A Few useful Metrics
Given the speed of change, it makes no sense to quote absolute numbers (they will be out- dated before this book is published). Rather, it is a better idea to point to metrics that are important to consider when choosing information technology to support needs in phar- macy practice.
3.2.1.1 Processors
The clock rate is the most important metric in defining the speed of a computer. In simple terms, it is the time it takes to flip a zero into a one and vice versa—the basic operating instruction of a computer. Thus, a clock rate of 3.0 GHz means this happens three bil- lion times a second. Choosing a computer with the highest clock rate at any given point in time will cost the most and may be overkill, depending on how the computer will be used. Talk to people and read about those performing similar tasks using computers of different clock rates. A faster rate may be a waste of money. As when you shop for a car, do not be lured by the fastest, but rather by that which gets you there the most economi- cally and reliably.
3.2.1.2 Physical Memory
Physical memory is frequently more important than processor speed in defining how well a computer will function on the applications that are used regularly. Today, memory is typ- ically in the 1–10 gigabyte (GB) range, with 1 GB meaning one billion bytes can be stored. A byte is eight bits (ones or zeros) and 1 GB is equivalent to one billion bytes. Too little memory does not mean that applications will not run, but rather that they will run more slowly as a result of paging and swapping, which are processes controlled by the computer’s
26 ◾ Philip E. Bourne
operating system (e.g., Windows, Linux, or Mac). They share the memory among the appli- cations running by copying parts of memory to the computer’s hard disks and then copy- ing them back—an inefficient process. The hardware requirements are usually specified for the software purchased (or downloaded) so be sure to have enough memory for the applications to be run.
3.2.1.3 Graphics Cards
Also known as the video card, this is an additional hardware component responsible for a number of applications involving display and rendering (manipulation) of graphics and video. These days, almost any graphics card will perform well for typical applications; however, for gaming and, more importantly, applications for manipulating digital x-rays, MRI scans, etc., the type of card may be important. In most cases, the software used will dictate the best graphics card to purchase.
3.2.1.4 Disk Storage
It is perhaps the revolution in disk storage more than any other hardware component that has driven the IT revolution and is having an impact on pharmacy practice. As I write this, Gmail, Google’s free e-mail offering, is registering that over 7,000 terabytes (TB) of disk storage are available for users worldwide to store their e-mail freely. At the same time, YouTube is receiving 14 hours of video uploads every minute, all stored free.
How can this be possible? In part this is because Moore’s law holds for disk storage, too, and partly because new business models have emerged that use these cheap resources to deliver services for the opportunity to advertise to the user. For those of us who remember the days of floppy disks and 1 MB storage, this is indeed a revolution—no pun intended.* Laptops now typically have disk storage of over 100 GB and the main issue becomes main- taining the integrity of the data (which we will get to subsequently). When disk storage is considered, the following issues become important in addition to capacity:
rotational speed—the faster a disk rotates, the faster data can be read or written; •
average seek time (in milliseconds)—the time it takes to find data on the disk; •
temporary buffer size—a cache of memory to maintain data recently read from or •
written to the disk;
mean time between failures (MTBF)—the reliability of the disk, because it is a •
mechanical device, after all. Solid-state storage (similar to physical memory and often called chip-based hard drives) is more expensive but has no moving parts and will have fewer failures†;
* Disks are currently mostly mechanical with revolving parts (hence the pun and a recognition that mechanical items fail).
hot swapping—more important in desktops and servers in order to be able to swap a •
disk out without powering off the computer or rebooting; and
random array of inexpensive disks (RAID)—serves the purpose of generating a large •
amount of redundant storage for large applications like maintaining a pharmacy information system.
3.2.1.5 Network Cards
Network cards are of two types: hardwire and wireless. Laptops typically contain both (do not buy a laptop without a built-in wireless card); desktops and servers typically have only hardware, but wireless can be added using a USB port (see next section). Speed of the card is rarely an issue if a recent card is used because the bottleneck to network speed invariably lies elsewhere. Each network card has a unique physical Ethernet address, which ultimately is what identifies an individual computer among the many millions accessing the Internet at any given moment. The address is represented as six parts, each consisting of two hexa- decimal numbers (e.g., 08:00:20:03:72:DC). We will come back to this shortly.
3.2.1.6 USB Ports
We are in a fortunate era in computing where most hardware manufacturers support uni- versal serial bus (USB) adaptors that make it simple to add a variety of peripheral devices to any computer. The number of USB ports on a computer can be an important factor when purchasing a desktop or laptop, as can the speed of these ports. To date, there have been three USB releases, with each one markedly faster than the previous. Be sure that the computer used or to be purchased has the latest release.
3.2.1.7 Firewire Ports
Firewire (also called IEEE 1394 interface, i.LINK, and Lynx) is a frequently used video specification typically found on camcorders and other devices. It is not necessary to have a firewire port because firewire to USB cables is very common and typically shipped with any purchased video equipment.
3.2.1.8 DVDs/CDs
DVDs and CD read/write devices are standard on many laptop and desktop computers. CDs store up to 700 MB; DVDs can store between 4 and 17 GB and are more useful second- ary backup storage devices for materials that are accessed occasionally. Faster media such as USB drives are better for materials accessed more frequently. Storing movies, photos, and other media files on DVDs is typical. Speed of DVD writing is expressed as a number times the speed of the original drives from around 1995. Drives at the time of writing will typically exhibit write speeds of 20× their original counterparts.