HARDWARE
REQUIREMENTS

The following Document is published and maintained by QHR Technologies. The content is subject to change without notice, as technology and systems change without notice. Please refer to this page before making any changes or additions to your clinic. 

Last updated: September 24th, 2020.

The following applies to Accuro version 2017.01+.  If you need requirements for an older version, please contact QHR Technologies.

Hardware Requirements for Accuro EMR

Accuro is an Electronic Medical Records program designed for clinics. Accuro is a client-server design that has 2 main components it needs in order to work: the database and the Accuro application.

The database needs to be set up on a single server computer within the clinic, which we will call the Database Server. There is only one database server for the entire clinic and this server will host all of the data for the clinic.  Accuro is a program that needs to be installed on every workstation in the clinic and it is the program you work in. Since there are many workstations all with Accuro installed and only one database, it means that all of the users in the clinic are sharing the data in real time. This also means that there is no actual Accuro EMR data on the workstations; only on the server.

Workstations


Accuro / Medeo of any version are only supported on operating systems that are currently supported by the maker of the operating system.

Windows PC Workstation, Laptop, or Tablet
Operating System: Windows 10, Windows 8 (previous versions are no longer supported)  
Processor speed of 2.0 GHz or faster,
RAM: 2 GB (6 GB or higher Recommended)
Screen Resolution 1024x768 or higher (Multiple monitors recommended)

Apple Workstation or Laptop:

*Users should only update to a new macOS once it has been approved by QHR for use with Accuro. For the operating systems that have been tested and are compatible with Accuro, please see below.

Operating System: OS 10.13 - 10.14 (Note: please do not update to newer OS versions until they are listed on this page)
Screen Resolution 1024x768 or higher

Accuro runs best on a Windows PC, but does work on Apple Mac workstations as well. There must be at least one Windows PC workstation in the clinic to handle faxing and billing submissions. For those looking to run a Mac-only workstation set-up, contact QHR to review the set-up first.

Phones and Apple/Android Tablets:
Accuro does not run directly on phones or non-Windows tablets. To access your data from these devices, you will be using the included Accuro Mobile.
Accuro Mobile is a web application which can be accessed on your iPhone, iPad, or other tablet and smartphone devices that have web browser capability. Accuro Mobile is not the full version of Accuro, but allows viewing of your scheduler, patient records, inbox, plus the ability to record patient notes and billing. If you are an ASP customer you can take advantage of Citrix offering for mobile devices.

 Device Types:
  • Windows PC: PC Stands for Personal Computer and must be installed with Microsoft Windows. Windows PCs run Accuro as a workstation and may also be used as remote stations. QHR is not brand specific. Windows PC is the most common type of workstation and is the standard that QHR builds Accuro to run on.

  • Mac by Apple: Mac computers run Accuro as a workstation and may also be used as remote stations. There is a requirement for one (or more) of the workstations to be PC machines running Windows operating systems to support label printing, faxing, scanning, and potentially other applications like hospital system or PACS access. Accuro was not designed specifically for Mac, so Windows PC workstations are the recommended platform.

  • iPhone by Apple: This runs the Accuro Mobile version, which is a trimmed down version of Accuro with messaging, tasks, labs, schedule view, patient chart view, and clinical notes entry. Accuro Mobile is designed to be used as a mobile access tool for quick access to charting, messages, and schedules.

  • iPad, Playbook, and Android Tablets: These run Accuro Mobile just like the iPhone, but additionally through applications like "Jump" and "2X", provides remote desktop access to run full Accuro (requires terminal server or RDP available Windows workstation).

  • Laptops and Full Tablets: Accuro runs on laptops and tablets that meet the minimum hardware requirements. This includes ability to type, mouse, and on screen drawing.

  • USB Key: For access to Accuro remotely (Accuro WEB), low cost Accuro USB keys are available for purchase that contain the full version of Accuro WEB allowing the key to be inserted in to an internet connected PC and launch Accuro (includes Java). Great for hospital access.

Java

Accuro runs on Oracle Java which is included with each installation of Accuro within the Accuro folder on every workstation. It is freely downloaded from www.java.com.

Current supported Java Version Java 8

Local Accuro installs use their own packaged Java environment which is Java 8.

Network


Wired network
10/100/1000 Base T (1000 Base T/Gigabit recommended)

Wireless network
Accuro will run over a wireless network, though environmental factors can affect performance.
54 Mbps (or higher recommended)

Server


The server hosts the database for the entire clinic. The performance of the server has the single biggest impact on the performance and reliability of the system. Accuro can be installed on a server located on site at the clinic or business, or a Cloud service (also known as ASP) where you don't need a physical server at all, instead accessing your system online. If you do prefer to host your own, here are requirements for the server. Note that the more users you have using the server at one time, the more powerful the server should be. Maintenance of the local server, (for example, but not limited to the hardware, third party software, SQL databases, backup etc..) is the responsibility of the customer.  Many customers choose to go with our ASP solution as QHR will manage these in our hosted environment for them.

*** It is highly recommended you purchase Windows Server and SQL separately and NOT go with one of Microsoft's SQL bundled options.  The bundled options are preconfigured with nonessential services that can take up system resources if you’re not using them which can negatively impact performance.

*** For best performance, SQL Server should be installed on a separate server from any other services on your network, such as a terminal server or domain controller etc..  Doing so could negatively impact the performance of Accuro. Sites that disregard this recommendation may be asked to separate these servers before QHR can investigate any performance issues.

Local Install Server Requirements:

The first important recommendation is that your data server is a Dedicated Database Server, meaning it is not also being used as a workstation or hosting other applications or services.  

1-5 users


5-10 users

10-25 users

25-50 users

50+ users

*Large Sites over 50 users should contact QHR to discuss requirements*

Operating System (OS)

Windows 8
Windows 10
Windows Server 2012 R2
Windows Server 2016
Windows Server 2019

Windows Server 2012 R2
Windows Server 2016
Windows Server 2019

Windows Server 2012 R2
Windows Server 2016
Windows Server 2019

Windows Server 2012 R2
Windows Server 2016
Windows Server 2019

Windows Server 2012 R2
Windows Server 2016
Windows Server 2019

Database System

Microsoft SQL Server: 2012 - 2019
Express Version not recommended due to database administration, memory and size limitations.

Processor

2+ GHz, Dual Core

2+ GHz, Dual Core

2+ GHz, Quad Core or higher

2+ GHz, Quad Core or higher

Dual 2+ GHz, Quad Core or higher

RAM

8 GB - 16 GB

8 GB - 32 GB

16 GB - 32 GB

32 GB - 64 GB

64 GB +

Hard Drives (Storage)

Hard Drive Layout recommended as a
Mirrored configuration and for
optimum performance, a RAID10.

Redundancy highly recommended.

Hard Drive Size Varies depending on the size of clinic and data entered. Typical growth rate to be roughly  1 GB/year/Physician.

Disk1: OS

Disk2: Data/Documents

Disk1: 60+ GB

Disk2: Variable*

Disk1: OS

Disk2: Data/Documents

Disk1: 60+ GB

Disk2: Variable*

Disk1: OS

Disk2: Data/Documents
Disk3: Logs

Disk1: 80+ GB

Disk2: Variable*
Disk3: 40+ GB

Disk1: OS

Disk2: Data
Disk3: Logs

Disk4: Documents Database

Disk1: 80+ GB

Disk2: Variable *
Disk3: 60+ GB

Disk4: Variable *

Disk1: OS

Disk2: Data
Disk3: Logs

Disk4: Documents Database

Disk1: 100+ GB

Disk2: Variable *
Disk3: 80+ GB

Disk4: Variable *

Network Connect

Ethernet NIC Gigabit

Other

Antivirus, Firewall, Backup
Please Note that Backup is not included with Accuro automatically. It must be ordered through QHR. Ensuring a backup process is in place is the responsibility of the customer. Please contact QHR to discuss options. 1-866-729-8889.

*Data size is variable; dependent on size of clinic and data imported. Typical growth rate of Data (including documents) is 1GB per full time physician per year. Documents (the scans and faxes received) typically make up twice the amount of space of Data (the database). It is recommended that the Documents be stored in the Documents Database as opposed to a file structure, although both methods are supported. 

Given Documents (Scans and Faxes) can take up the most amount of storage space, please ensure your scanners and faxes are being set to reasonable resolutions. High resolutions can create storage ballooning of up to 100x. (ie: a reasonable file size is 20-50KB per page, and a high res file can be 5,000KB per page. You can imagine the storage difference!)

*** A dedicated Microsoft Windows EMR Server for the above is highly recommended in order to achieve maximum performance and reliability of your system. 

Best results for performance are achieved when the server's main purpose is to run your EMR database. It is standard for networks to have a second, usually an existing, server that runs the domain, active directory, and other programs. 

Although it is possible to run the EMR server on the same machine as the network server, it is not recommended for performance reasons and therefore the above requirements would need to be adjusted for a consolidated server approach. For all Workstations and Servers, please consult with your hardware provider for other important components like (but not limited to) UPS device, backup (unless QHR backup is chosen), Antivirus, Network Devices, Firewall, SQL and other network/workstation software licensing, and Maintenance Plans. QHR is able and happy to speak directly to the hardware provider upon request.

Where to get Hardware
QHR is open to working with the hardware vendor of your choice. Contact us if you would like a list of preferred vendors in your area. Please ensure your hardware vendor offers full service for hardware, installation, and support. QHR is not brand specific with hardware, as long as it meets the hardware requirements listed above. 

Database Backup 


It is required that you ensure your data is being backed up regularly. The database server contains all of the data and if anything happens to the server, the backup will be the only way to recover the data. It is best to plan for worst case scenario such as theft of the server.

QHR offers a backup service that automatically backs up your database daily and stores the data in the QHR secure data centre. In order to have QHR backup you must first contact QHR to sign up for the service to be installed. There is a monthly fee depending on how much data you have to backup.

Application Service Provider (ASP)


An alternative to buying a server. Hosted and provided by QHR giving you access to Accuro over the Internet from anywhere.

ASP stands for Application Service Provider. This is essentially a server hosting service that provides you with a server, backup, and access via the Internet to your Accuro EMR. This means that an EMR server is not required to be installed to run Accuro at your clinic. ASP is growing in popularity because it eliminates the need for the clinic to be responsible for a server, backup, and maintenance. From a cost perspective, ASP is an additional monthly fee as opposed to the cost of a server which has a larger up front cost.

ASP is Internet reliant. This means that ASP is right for you as long as your Internet connection is reliable and high speed. 

The Requirements for ASP are;

Internet Speed
Internet speed varies greatly on how many users, and the role and activities those users take. As a general rule faster is always better however, most internet service providers have business packages that are close to 5mbps down and 1mbps up as a minimum (2mbps up or more recommended) . If you find you add a lot of users or have a document heavy process you may need to increase your internet speed connection to compensate.

Windows PCs
Operating System: Windows 10, Windows 8 (previous versions are no longer supported)
Recommended Web Browser: Chrome (current)
Other Web Browsers: Microsoft Edge (based on Chrome), Internet Explorer 11, or Mozilla Firefox (current)
Citrix Web Client: https://citrix-ca.cloudwerx.com : click the “Windows” link under the log on screen and click “Step 1”   - Please note, version 4.6+ is required
Screw Drivers Plug-in: https://citrix-ca.cloudwerx.com : click the “Windows” link under the log on screen and click “Step 2”
Cloudwerx Plug-in: https://citrix-ca.cloudwerx.com : click the “Windows” link under the log on screen and click “Step 3”

Apple Macintosh PCs

*Users should only update to a new macOS once it has been approved by QHR for use with Accuro. For the operating systems that have been tested and are compatible with Accuro, please see below.

Operating System: Apple Mac OS 10.13 - 10.15 (based on Apple support policy for current release and 2 prior)
Recommended Web Browser: Chrome (current)
Other Web Browsers: Safari 9+, Microsoft Edge (based on Chrome), or Mozilla Firefox (current)
Citrix Web Client: https://citrix-ca.cloudwerx.com : click the “Mac OS X” link under the log on screen and click “Step 1” - Please note, version 12.5+ is required
Screw Drivers Plug-in: https://citrix-ca.cloudwerx.com : click the “Mac OS X” link under the log on screen and click “Step 2”

Tablets, Android or iPAD
Tablets that are capable of running the most recent versions of the Citrix receiver can be used to run the full featured version of the application as opposed to Accuro Mobile.  Very old tablets may not be capable of running the required version, please check to see if your device can install the most recent version of the Citrix receiver from the relevant App store (as an example as of the time of this revision, iPADs generation 1 are not able to run the current Citrix receiver).

Contact QHR for information and pricing. accuro@qhrtechnologies.com

Third Party Hardware


Swipe Card Readers (currently only available in BC and ON): Many card readers will work but QHR has only tested the Magtek Dynamag card reader (P/N: 21073062) using encryption levels 1 or 2. Encryption level 3 (also known as Triple DES Encryption) is *NOT* supported.
We cannot guarantee others will work with Local and/or ASP Hosted systems.

Supported swipe card readers are available from:

https://www.cdw.ca/product/magtek-dynamag-magnesafe-swipe-reader-centurion-magnetic-card-reader-us/4760411?pfm=srh

https://www.barcodesinc.com/magtek/part-21073062.htm

https://www.directdial.com/ca/item/magtek-magnetic-stripe-reader/21073062

 

Printers - Standard: Accuro works with any modern laser or inkjet printer that can successfully print from the workstation.

Printers - Label: Accuro works best with the Dymo 450 Label printer. For ASP customers, label printing is not supported on Mac workstations. Label printing does work with Windows workstations (can print from a Mac to a PC where the label printer is connected).

Printers - Prescription: Accuro works best with the Epson T88V Receipt printer. Note that standard printers can be used as prescription printers as well. The receipt printer is an alternative which offers a smaller paper size and continuous paper feed.

Scanners: Accuro works with any scanner as it does not directly connect to the scanner. Rather, Accuro requires the scanner to place the scans in to a folder on the network, and Accuro displays the contents of the folder in the Documents section for the user to "File". A recommended scanner is the Fujitsu Scansnap due to its low cost, small size, and ease of use.  Given Documents (Scans and Faxes) can take up the most amount of storage space, please ensure your scanners and faxes are being set to reasonable resolutions. High resolutions can create storage ballooning of up to 100x. (ie: a reasonable file size is 20-50KB per page, and a high res file can be 2,000KB per page. You can imagine the storage difference!)

Fax: Accuro connects to Microsoft Fax to send faxes. A modem is required in a single elected workstation (not the server) which will become the new outgoing fax machine for the clinic. Any user that faxes in Accuro can do so which automatically routes to the fax workstation and is monitored for successful transmission by the user at the fax workstation. Fax in is set up by configuring Microsoft Fax to save the TIFF fax files in to a directory on the network (UNC path). Users then use the Documents section of Accuro to upload from the directory in to the patient chart.
IMPORTANT NOTE: Microsoft Fax on the workstation must run under a single shared user account so that the status of faxes sent and received can be viewed. Logging in to the fax workstation as another user will not display the faxes as the Fax Console is user specific.

QHR recommends a Serial modem over USB modems as from our experience they are more reliable when communicating to other fax machines/modems.

Single line fax modem:
US Robotics 5686G (http://www.usr.com/products/modem/modem-product.asp?sku=USR5686G)
Approx $100
Require a serial port.
DO NOT INSTALL USR DRIVERS, USE MICROSOFT DEFAULT DRIVERS.


All other Fax machines should be taken off the same line as the one to be used for Accuro server so no cross talk or other communication issues can occur on the line preventing either out or inbound faxes.

Internet Fax: As an alternate to Fax modems, Accuro connects to a Internet Fax web service called UNITE. This allows all faxing to be run through the Internet and no longer requires you to have a fax line, fax machine, or fax modem. 
www.unite.ca.

Remote Access


The Methods for Remote Access (ability to access Accuro from any internet connection) include the following:

Access Via:

Technology

Local Install

ASP

Accuro Mobile

Accuro web application for Internet browser access.
Uses https / ssl security over port 10443 or alternative.

YES

YES

Accuro Web

Accuro webstart application for full Accuro access remotely.
Uses https / ssl security over port 10443 or alternative.

YES

YES

Accuro USB

Accuro webstart application for full Accuro access remotely.
Uses https / ssl security over port 10443 or alternative with application launch from a USB key to avoid download.

YES

YES

ASP

Accuro ASP Citrix access and Microsoft RDP Access
The primary method of access to Accuro for ASP subscribers.

NO

YES

Remote Desktop (Microsoft)

Microsoft Windows Desktop Access.
Not directly supported by QHR, but a popular method of Remote Access and requires a terminal server or user specific workstations.

YES

YES



What is the difference between Accuro Mobile, Accuro Web, and Accuro USB?


Accuro Mobile is a browser based view of the EMR with limited functionality but it is very fast over slow connections and is designed to fit in small screens like your iPhone or iPad.

Accuro Web is the full Accuro program, launched through the Internet. It requires high speed internet access and must be launched from a workstation level computer (see the Workstation requirements at the top of this page).  

Accuro USB is the full Accuro Web program, with all of the files needed contained on the USB key to save the download time over Accuro Web. The way this works is you order your Accuro USB key from QHR, then you put it in any computer with high speed internet access, and open the Accuro EMR program right off the key. It will ask you the first time for you Internet Address, and has its own Update Accuro. It also contains all of the required Java files so you don't need to install anything on the computer directly. A great tool for Hospital access (though you must be an administrator on the computer you are running it on in order to update the application, alternately running an update off site before bringing it in to the restricted network).

NOTE: For ASP subscribers (see above), Accuro Mobile and Remote Access is set-up for you. 

Accuro Mobile


Accuro Mobile is a browser based (Web) application that allows you to access your EMR data from within an Internet browser. Accuro Mobile is primarily read only access of your scheduler, patient demographics, address book, Virtual Chart, and Home section (messages and labs). It does have some functions like ability to enter clinical notes on patients, send messages to staff, and review labs.

Technical Set-up of Accuro Mobile QHR will install Accuro Mobile and all required components for you on either you on your server. Since it is a web application, it is hosted using web server software which is Apache Tomcat. Once QHR installs Apache Tomcat and Accuro Mobile, you then need to ensure that your Internet Address is static and you have opened port 10443 forwarded to the "web" server. If you are not sure what this all means, contact your IT or call QHR).

Once set up, Accuro Mobile will be accessible through any browser by entering in the Internet Address of your clinic, followed by "/mobile". As an example, if my address is  69.255.255.255 then my access to Accuro Mobile will be https://69.255.255.255:10443/mobile. You can also arrange to have a domain name assigned to your address so you have something easier to remember that a numbered address.

Accuro Web



Accuro Web is the full Accuro program, launched through the Internet. It requires high speed internet access and must be launched from a workstation level computer (see the Workstation requirements at the top of this page).  

Technical Set-up of Accuro Web QHR will install Accuro Web and all required components for you on either you on your server. Since it is a web application, it is hosted using web server software which is Apache Tomcat. Once QHR installs Apache Tomcat and Accuro Web, you then need to ensure that your Internet Address is static and you have opened port 10443 forwarded to the "web" server. If you are not sure what this all means, contact your IT or call QHR).

Once set up, Accuro Web will be accessible through any browser by entering in the Internet Address of your clinic. As an example, if my address is  69.255.255.255 then my access to Accuro Mobile will be https://69.255.255.255. You can also arrange to have a domain name assigned to your address so you have something easier to remember that a numbered address.

Accuro USB



Accuro USB is a physical copy of the full Accuro Web program, with all of the files needed contained on the USB key to save the download time. The way this works is you order your Accuro USB key from QHR, then you put it in any computer with high speed internet access, and open the Accuro EMR program right off the key. It will ask you the first time for you Internet Address, and has it's own Update Accuro. It also contains all of the required Java files so you don't need to install anything on the computer directly. A great tool for Hospital access (though you must be an administrator on the computer you are running it on in order to update the application, alternately running an update off site before bringing it in to the restricted network).

To order an Accuro USB key, contact QHR at accuro@qhrtechnologies.com.

Technical Database (SQL) Configuration and Maintenance 


-- Information for your local IT Provider--

QHR does not directly support your database server unless you have a server maintenance plan under Extension of the Cloud (see above). It is the responsibility of the clinic to make sure the database server is healthy. QHR is happy to answer any questions.

Database Configuration:

  1. Ensure the correct version of Microsoft SQL Server installed with appropriate licensing.
  2. Accuro requires the database to be set up for connection using the sa account by default.
  3. Enable TCP/IP and use port 1433 by default. Alternate ports can be configured on request.
  4. The boot drive for SQL must have >10% available drive space for temp files.
  5. Set both the Data File and the Log File of the database to use a fixed growth size of 250MB.

Database Maintenance

Database maintenance plans are recommended in order to optimize performance of the system. QHR does not run these checks on your database so please contact your local IT to arrange maintenance for this. They are not complex steps, and can be done directly using Microsoft SQL Server Tools. This is by no means considered a complete maintenance plan, and should be modified to meet the needs of your network.  If you are unsure or your local IT has any questions, please contact us.

Every Week:

Every two Weeks:

Every month:

Defragment the Physical Disks on
the database server.

Check Database Integrity

Clean up History (keeps msdb size down);
clear out anything older than 4 weeks

Reorganize Indexes (this is not a REBUILD),
Tables and Views

Compact Large objects

Update Statistics, Tables and Views

Shrink Log (LDF only)

Rebuild all Indexes

QHR Client Services


For application support, or inquiries.

Email: accuro@qhrtechnologies.com

Phone: 1-866-729-8889

Accuro: Click on Help, Send Feedback