SETUP MANUAL Midmark Products over Thin Client Environments Version 1.8 Part Number: 3-100-1126 Revision B
Table of Contents I. INTRODUCTION... 1 A. RELATED DOCUMENTS... 1 B. CAUTIONARY NOTE... 1 C. GLOSSARY OF TERMS... 2 II. THIN CLIENT BACKGROUND INFORMATION... 4 A. TYPICAL THIN CLIENT ENVIRONMENTS... 4 B. APPLICATION MODELS... 5 Windows Terminal Services with RDP Clients... 5 Citrix MetaFrame for Windows with ICA Clients... 6 III. SYSTEM REQUIREMENTS... 8 A. MINIMUM NETWORK PERFORMANCE REQUIREMENTS FOR REAL-TIME ECG ACQUISITION... 9 IV. COM PORT REDIRECTION (MAPPING)... 10 A. COM PORT REDIRECTION (MAPPING) ON WINDOWS 98 WITH WINDOWS SERVER 2003... 12 B. COM PORT SETTINGS ON CLIENT COMPUTERS... 12 V. RECOMMENDED PRACTICES... 13 A. ECG WAVEFORM SMOOTHING... 13 B. USER PROFILES... 14 C. RECOMMENDATIONS FOR HOLTER... 15 APPENDIX A. REFERENCES... 16 i
I. Introduction The Midmark ECG, Spirometry and Holter products can be used in thin client or fat client (also called full client) environments. This document contains recommended practices for end-users intending to deploy Midmark products in thin client environments. The information in this document applies to users of the ECG, Spirometry and Holter products via the IQmanager as well as to users of Electronic Medical Record (EMR) applications that have integrated these products. This document is appropriate for system administrators considering deployment of this software in a clinical environment, technical personnel responsible for installing and configuring the software and technical support personnel. Midmark ECG and Spirometry products are inherently real-time applications, acquiring real-time waveform data using a computer s serial ports. Unlike running products on a fat client PC, data transmission could be delayed while running over a thin client network. Available bandwidth and other network performance parameters are major considerations in thin client environments. The Midmark Spirometry products require much less bandwidth than ECG and can operate over a much wider range of network conditions. The Midmark Holter software is not a realtime application and does not require much network bandwidth or system resources. A. Related Documents Application Note: Using Midmark IQpath Software Applications that use version 8.0 or later of the Midmark ECG and Spirometry software can now provide the benefits of improved communications performance provided by virtual channels in a thin client environment. If you are using Midmark IQpath software for thin client network, please read the application note. B. Cautionary Note The Midmark ECG software allows you to review and edit stored ECG reports as well as acquire new ECG data for analysis from the ECG module. Review and edit functionality involves viewing static forms-based displays and does not pose any problems when operating in a thin client environment. The acquisition process is a real-time process. During acquisition, the Midmark ECG software reads data from the ECG module via a serial port and displays ECG waveforms in real time on the display screen. Because of the real time nature of the ECG acquisition process, it is possible that the ECG software may not work in all thin client network environments. 1
Midmark tested the Midmark ECG software under different network conditions using a thin client environment and verified that the software works correctly when the network meets certain minimum performance requirements (see Section III, System Requirements for more information). Midmark will not be responsible if the network does not meet the minimum requirements. If the customer cannot determine that their network meets the minimum requirements and wishes to deploy the Midmark ECG and Spirometry software in a thin client environment anyway, the customer must first test these products on their own network; the alternative is to configure the computers running the ECG acquisition process to run in a fat client configuration and to use the thin client configuration for all other clients that need to perform review and edit operations. In addition, networked systems are complicated and the addition of terminal servers and thin client software adds further complication. Midmark highly recommends that the customer configure and test this software in a test environment prior to going live. The minimum performance requirements specified in Table 3-2 and Table 3-3 are established with the simulation on a wired thin client network. Due to a wireless thin client network being subject to more interferences and its performance is not as stable as a hardwired network, MDG DOES NOT recommend running the IQmark ECG or the IQecg in a wireless thin client network environment. C. Glossary of Terms Term Citrix Independent Computing Architecture (ICA) Glossary of Terms Description Citrix ICA, which is similar to Microsoft Terminal Services, consists of two components: one each running on the server and the client computers. Citrix Metaframe Presentation Servers are add-ons to Windows Terminal Services and constitute the server component. The Citrix ICA client must be installed on the client computer. Go to www.citrix.com for more information. 2
Term COM Port Mapping Microsoft Terminal Services Remote Desktop Protocol (RDP) Remote Desktop Connection (RDC) Thin Client Virtual Channel Virtual Channel Driver Dynamic Link Library (DLL) Glossary of Terms Description COM port mapping allows the application running on the server to access the serial (COM) ports on the client computer. In COM port mapping, a virtual COM port in the server (i.e., COM 11) can be mapped to a physical COM port on the client computer (i.e., COM 1) during a thin client session. Both Microsoft Terminal Services (using RDP 5.1 or later) and Citrix ICA support COM port mapping. Prior to version 8.0 of the Midmark ECG and Spirometry software, COM port mapping was the only way to use the Midmark products in a thin client environment. Microsoft Windows Terminal Services is a service component of the Windows Server operating systems that enables thin client operation. Terminal Services is available on all versions of Windows 2000 Server and all versions of Windows 2003 Server. RDP is the communication protocol used by Microsoft Terminal Services to communicate between the terminal server and a client computer. RDC is the method of connecting to a terminal server using Microsoft Terminal Services from a client computer. In a thin client environment, the application program runs on a server computer. Client computers can connect to the server and use application programs installed on the server. The server transmits the graphical user interface to the client computer. The client transmits the user s input and I/O data from connected devices to the server. A virtual channel is a software extension to Microsoft Windows Terminal Services or Citrix ICA that adds functional and performance enhancements to a thin client application. A virtual channel application has two parts: an application or a component within an application that runs on the terminal server, and a Dynamic Link Library (DLL) that runs on the client computer. The client side DLL is called a virtual channel driver DLL. The virtual channel mechanism provides a robust communication channel that guarantees custom application data is delivered without loss of data or data corruption. The virtual channel driver DLL is installed on the client computer. In the case of the Midmark virtual channel software, the virtual channel driver DLL communicates directly with the ECG or Spirometry modules and sends ECG and Spirometry data to the application running on the server. 3
II. Thin Client Background Information Thin client operation on Windows platforms is enabled by Windows Terminal Services, which are supported by all versions of Windows server operating systems, including all editions of Windows NT Server, Windows 2000 Server and Windows 2003 Server (32-bit). In the Terminal Services environment, an application runs entirely on the Terminal Server; the Terminal Services client performs no local processing of application software. The server transmits the graphical user interface (GUI) to the client and the client transmits user input back to the server. A. Typical Thin Client Environments From a system performance perspective, it is almost impossible to have two identical thin client deployments that can be used to compare performance measurements because no two computer networks are exactly the same. A thin client deployment involves networking, server and client configurations, operating system, thin client communication protocol, software applications, security, and usage patterns. The following table lists possible configurations of typical thin client environments. Only Microsoft Windows with Intel-based CPU architectures are considered. If you have questions about your specific configuration, please call Midmark Support Services at (800) 624-8950, ext. 2. Components Network Topologies and Connections Server Hardware Server OS Possible Configurations LAN (Gigabit Ethernet, 100 Base-T or 10 Base-T) WAN (T1, T3, Frame Relay, ISDN, xdsl or ATM) VPN (Virtual Private Network for remote connections) Direct Dial-up (without using RAS, ICA only) Windows RAS (Remote Access Service for dial-up) Dedicated Server (dual-processor, 1GB RAM, SCSI interfaces) Desktop PC One or more servers (server farm or server clusters) Windows Server 2003, 32-bit (Standard/ Enterprise Edition) Windows 2000 Server (or Advanced Server Edition, Data Center Edition) Windows NT Server 4.0 Terminal Services Edition Service Packs or hot-fixes may be needed 4
Components Possible Configurations Server Services Windows Terminal Services (Server Software) Citrix WinFrame Citrix MetaFrame 1.8 Citrix MetaFrame XP (Feature Release 2, 3) Citrix MetaFrame Presentation Server 3.0, 4.0 Client Hardware Desktop PC (full client) Aging PC Dedicated thin client device (HP T5000/Evo, WYSE WinTerm, NCD ThinStar, etc.) Client OS Windows XP, Vista, 7 Windows CE (including CE.NET 4.2) Windows XP Embedded Transport TCP/IP SPX, IPX, NetBEUI (ICA only) PPP Client-Server Microsoft Remote Desktop Protocol (RDP, version 5.1 or the latest 5.2 Communication for Midmark products) Protocol Citrix Independent Computing Architecture (ICA, version 5.x, 6.x or 7.0) B. Application Models From an application-platform perspective, two major client-server communication protocols are widely used on Windows platforms: Citrix Independent Computing Architecture (ICA) and Microsoft Remote Desktop Protocol (RDP). Protocol is based on the application model: Citrix MetaFrame Servers with ICA clients Windows Terminal Services with RDP clients Midmark products have been validated in both application models. Windows Terminal Services with RDP Clients Windows NT Server 4.0 Terminal Server Edition, Windows 2000 Terminal Services and Windows Server 2003 Terminal Services support both the native Microsoft RDP protocol, as well as Citrix ICA (via the Citrix MetaFrame add-on). Since Windows 2000, Terminal Services are built into server operating systems as standard server-based services. Terminal Services can be installed or removed after the server OS is installed. RDP 4.0 is native to Windows NT Server 4.0, Terminal Server Edition RDP 5.0 is available in Windows 2000 Terminal Services 5
RDP 5.1 is installed by Windows XP Professional, Windows CE.NET 4.2 or Windows XP Embedded Windows Server 2003 Terminal Services contains RDP 5.2 Prior to version 5.1, RDP supported COM port mapping for only serial printers; therefore, Midmark ECG and Spirometer products cannot run on any earlier versions than RDP 5.1, since they use the client COM port to send the data to the server. The Midmark ECG and Spirometer products can only work with Windows Server 2003 Terminal Services and the Windows XP Professional / Windows 7 Clients. In some small thin client deployments, you can use a Terminal Services client to directly connect to the terminal server through RDP to gain access to Windowsbased applications and shared resources. Windows Terminal Services should be installed and configured on servers, while client software should be installed and configured on client computers. On Windows desktops, the client software is Remote Desktop Connection, which is pre-installed with Windows XP Professional. The software can be installed independently on other operating systems, no service packs or hot fixes are required. On dedicated thin client terminal devices, RDP is usually built into the embedded Windows-based operating systems, such as CE, CE.NET or XP Embedded. Windows Server 2003 improved thin client performance by improving the kernel of the OS, Terminal Services and the RDP protocol. This benefits both application models because they all fundamentally rely on the Windows Terminal Services. Citrix MetaFrame for Windows with ICA Clients Similar to the Microsoft RDP model, the Citrix application model also contains both server- and client-side components. Citrix MetaFrame Presentation servers are add-ons to Windows Terminal Services. MetaFrame servers are successors of Citrix WinFrame servers. MetaFrame servers run on top of Windows Terminal Services and provide many advanced features for real-world thin client applications, such as load management, application management, network management, resource management and Web publishing management. Most of Windows-based thin client environments use the Citrix MetaFrame application model. Currently, MetaFrame Presentation Server, Metaframe XP with Feature Releases (FR2 or FR3) and MetaFrame 1.8 are widely used server software in this application model. MetaFrame servers also support both Microsoft RDP and Citrix ICA connections. ICA is platform-independent, general-purpose distributed presentation 6
services architecture that supports DOS, OS/2, Windows (all versions since 3.x, Win16 or Win32), Windows CE, UNIX, LINUX and MAC OS. ICA is protocol independent, having been designed to run over TCP/IP, NetBEUI and IPX/SPX, while Microsoft RDP only supports TCP/IP. ICA is a presentation-level (layer 6 in ISO/OSI) protocol and runs over several transport layers. The ICA protocol only transports keystrokes, mouse clicks with movements and, screen updates to and from the client. The latest ICA client software is MetaFrame Presentation Server Client Packager, or Citrix Program Neighborhood (PN). During performance tests internally conducted by MDG, ICA limited the bandwidth assigned to each user, while Microsoft RDP did not. For example, with only one user logged on the Citrix MetaFrame server through a fast Ethernet connection (100Mbps), the ICA allocated less than 500Kbps to the user. Microsoft RDP allowed the user to use almost all of the 100Mbps bandwidth. 7
III. System Requirements Since network structure, topology and platforms differ between thin client deployments, the following requirements may vary slightly. Midmark strongly recommends setting up a validated pilot project in a lab-environment before deploying in a production setting. 1. Server Operating Systems Citrix MetaFrame Windows Server 2003, 32-bit (Standard/ Enterprise Edition), or Windows 2000 Server (or Advanced Server Edition, Data Center Edition), or Windows NT Server 4.0 Terminal Services Edition Service Packs or hot-fixes may be needed Windows Terminal Services mode Only Windows Server 2003 (with RDP 5.2) supports Midmark ECG and Spirometer. 2. Server Services / Software Windows Terminal Services and/or Citrix WinFrame or Citrix MetaFrame Servers ( 3.x, XP, 1.8) Citrix Server is required on non-windows 2003 servers 3. Client Desktop PCs (full client), laptops or Windows CE-based thin client terminals (e.g. HP T5000/Evo, WYSE WinTerm, NCD ThinStar, etc.) Serial ports or emulated serial ports Citrix MetaFrame Windows XP, Vista, 7, or Windows CE (including CE.NET 4.2) or Windows XP Embedded Windows Terminal Services mode Windows XP (with RDP 5.1) supports Midmark ECG and Spirometer. Microsoft Remote Desktop Connection, or Citrix Program Neighborhood (ICA clients) 4. Available Network Bandwidth (Requirements may vary for different networking structures for a single user, upon validation in end-user environment) ECG Real-time data acquisition (see Section III-A, Minimum Network Performance Requirements for Real-Time ECG Acquisition) Report review (no requirements) Spirometer Real-time data acquisition (160 kb/sec (20KB/sec)) Report review (no requirements) Holter 40MB of available space for each saved Holter test 5. ECG, Spirometer and Holter Devices (hardware) ECG module with serial port connection Spirometer handle with serial port connection CompactFlash Card reader for Holter products Table 3-1 Minimum System Requirements 8
A. Minimum Network Performance Requirements for Real- Time ECG Acquisition The minimum network performance requirements may vary slightly depending upon the client device, the thin client software version and the network configuration. Network Performance Parameter Recommended Network Performance Latency <= 25 ms Jitter <= 35 ms Packet Loss < 1% Bandwidth >= 256Kbps Table 3-2 Minimum Network Performance (Windows Running as a Thin Client) Network Performance Parameter Recommended Network Performance Latency <= 16 ms Jitter <= 10 ms Packet Loss <= 0.1% Bandwidth >= 300Kbps Table 3-3 Minimum Network Performance (Thin Client Device) 9
IV. COM Port Redirection (Mapping) Running ECG or Spirometry on thin clients requires serial port redirection (serial port mapping). For those clients that do not have serial ports, a USB-to-serial adapter can be used to emulate a serial port on a PC, in which case clients should be using Windows 2003 or XP-based PCs, not CE-based terminals. The USB versions of the ECG and Spirometer modules currently do not work on thin clients because there is no USB redirection available. For example, on a Citrix thin client environment, a user can redirect the client s COM1 port to the server s COM2 port by using this command: net use COM2: \\client\com1: In the above example, the ECG or Spirometry module connected to the COM1 port of the client computer will appear as if it is connected to the COM2 port on the server. To do this, create a thin client session on the client machine. From the desktop of the server (as viewed from the thin client session window), launch a command prompt window and execute the above command. This needs to be performed only once for each client machine, as long as the connections are set to be remembered. You can also add the above command to the logon script for the thin client s logon script. To use a Microsoft Remote Desktop Connection, the user can turn on the Serial Ports option on the Local Resources tab before making the connection to the Windows Server. 1. To open Microsoft Remote Connection, go to Administrative Tools and select Terminal Services Configuration. 2. Right-click RDP-tcp and then select Properties. 10
3. You need to make sure that the COM Port Mapping box is not checked. 4. From the client computer, open the RDP connection and click Options. 5. Click on the Local Resources tab. 6. Ensure that the Serial ports box is checked. Since Windows and Citrix ICA can remember serial port redirections based on the user profile, Midmark recommends that you map all client COM ports to the same port number on the server for easier serial port mapping management. For instance, always map COM1 on the client machine to COM5 on the server and similarly, always map COM2 on the client machine to the server s COM6. 11
When all users (client computers) use COM5 as the port for ECG testing, this setting will not change even if the user logs on from another computer or if the client computer is upgraded or changed. The COM port mapping can be computerindependent; therefore, there is no need for the software to re-do port scanning (Serial Port Auto Detect) when the software initiates ECG data acquisition. A. COM Port Redirection (Mapping) on Windows 98 with Windows Server 2003 When running Midmark products on Windows Server 2003 with a RDP 5.2 client on a computer running Windows 98, there might be an issue for ECG data acquisition and display. You may see garbled ECG data on the ECG real-time display screen or ECG lead-off indications. This is caused by an incorrect flow-control setting for the serial ports of a computer running Windows 98. The default flow control for COM ports is Xon/Xoff. This should be changed to Hardware. Users will have to change this setting on all client computers running Windows 98. This does not apply to Windows XP, 2000, 7 client computers or to the servers running Citrix Metaframe systems. B. COM Port Settings on Client Computers By changing the COM port settings on client computers (Windows 98, 2000,XP, or 7), the network bandwidth usage may be made more efficient. The following procedure is based on Windows 2000, though it is similar on other operating systems. 1. Start Settings Control Panel System Hardware tab Device Manager 12
2. Expand Ports (COM & LPT) choose the port that connects to the ECG module 3. Right-click Properties Port Settings tab Advanced 4. The settings should be set as follows: 5. Click OK, even if no changes were made. 6. Click OK to close each open window. DO NOT use X or Cancel. 7. Reboot the client computer (suggested for Windows XP). NOTE: When working in Windows 2000, you must click OK, not Cancel, to close the windows even if you did not change any settings. Then you must reboot the client computer to let Windows reload the serial port drivers. After rebooting the client PC, re-test ECG bandwidth usage, the results should be improved. Midmark has observed a 30-40% reduction in bandwidth requirements by implementing the above configuration changes in test environment. NOTE: If the end-user experiences loss of data (the software automatically reports this when it occurs), try to change the Receive Buffer setting to a lower number until the problem is resolved. V. Recommended Practices This section contains recommendations for configuring the Midmark software for optimal operation within thin client environments. Since network configurations are widely variable from one site to another, Midmark highly recommends implementing and validating the following suggestions in a lab-environment before deployment in a production environment. A. ECG Waveform Smoothing 13
If running Midmark ECG software with a version prior to version 6.3.3, Midmark recommends turning off the Waveform Smoothing option to conserve network bandwidth usage. From the IQmanager Configuration screen, click ECG Settings. On the Default Interpretation and Acquisition Display Settings, ensure the Waveform Smoothing box is unchecked. Since Midmark ECG software version 6.3.3, when the software detects that it is running in a thin client environment, the default is for this option to be unchecked. B. User Profiles By default, all configuration files of Midmark products are stored in the program directory for IQmanager and IQiC software. However this can be changed by EMR applications during the integration process. The configuration files include CommonConfiguration.cfg, ECGConfig.cfg and SpiroConfig.cfg, which are stored in the user s Application Data folder. Midmark recommends that users have different profiles individualized configuration settings are required. This usually does not require additional security permissions on a server computer; however, this is not a requirement. Multiple users can simultaneously log onto a server by using a single logon name, i.e. using shared user accounts. Midmark products function normally in this scenario except that configuration settings may be overwritten. This only applies to EMR applications that do not explicitly specify other locations for configuration files. Please verify this with your EMR vendor. 14
C. Recommendations for Holter To scan a Holter report from a CompactFlash card, the card reader can be installed on the server computer or on a client computer. If the card reader is installed on a client computer, the drive needs to be mapped to the server, so the software installed on the server can locate the card reader. The Holter security key (dongle) should be installed on the server. For more information, see your Midmark Holter product s manual. 15
Appendix A. References 1. Midmark Diagnostics Group, ActiveX User s Guide 2. Midmark Diagnostics Group, IQmark Products Over Thin Client Environments ActiveX Integration Guide 3. Midmark Diagnostics Group, IQmark Products Over Thin Client Environments Baseline Performance Assessment 16
Midmark Diagnostics Group 1125 W. 190 th Street Gardena, California 90248 Technical Support: 1-800-624-8950, Option 2 midmark.com Midmark Corporation 2010