Friday, August 31, 2007

DHCP blues

One of my front computers stopped connecting to my network last Thursday; this was kind of bad, because it is connected to the scanner--no scanning. When a computer fails at the office, it is always a bit of a crisis, and someone has to fix it.

In my office, I'm usually the first line of defense (I think every office has one of those, often by default). Most of the time, what I do is reboot the computer, and that often fixes things. This time, it didn't work. Then what you have to do is look to see if you can easily identify the problem; clicking on the "repair" button for the network didn't work.

This is when you call your IT person; every group should identify a professional IT person that they can call (not another physician or their neighbor's teenaged son). He came by that afternoon, and had a look at the machine. He tested the network card, connected the computer directly to the routers and did other things; I can't say exactly what, because I was seeing patients instead of taking care of the problem--which is the way it should be.

He finally identified the issue as a "DHCP server not working; must be replaced". He said that this is bad; he pointed to the router boxes in my IT closet. He assigned a static IP instead of a dynamic IP address to the computer, and said that this would fix it temporarily (whatever that is, it worked and the computer reconnected to the network). This reminds me of being in the garage with the car not working, and the mechanic tells me that the crankshaft is unglued; please just fix it.

Now that the problem was identified, I had to figure out who to call; the boxes in the back belong to SSHA (Smart Systems for Health), and we also go through the EMR company. I sent an email to SSHA, the EMR company, and OntarioMD. My very helpful contact at OntarioMD said to call the SSHA helpline, which is what I did; they took down the information, and gave me a 6 digit number for tracking purposes. On Monday, a new SOFA (Small Office Firewall Appliance), which is the box that had gone bad, arrived by courier. The IT person installed it for me, tested it, and now things are working again.

I am writing this to show the processes I am currently using to deal with IT problems. My computer systems are very complicated, since they involve internal hardware and software, EMR software, and hardware/software managed by an outside agency (SSHA). I am better at dealing with this than at the beginning, but it is still stressful. In order to deal with potential non EMR computer problems, it helps to have:

-a person in the office responsible for low level issues
-an IT person to call in for more difficult problems
-if you have things belonging to an outside agency, have their helpline number and keep the identification number for their hardware (they will ask you for it)

To give you a picture of my office last Thursday, my new nurse was in, my resident was in, my secretary was training a high school student for evening work, and the IT person was working on the broken computer. It was a little crowded and chaotic. There was no way I could work on fixing the computer.

On another note, my group's preventive services project is now finished, and we have mailed letters to all patients who are overdue for paps, mammograms, and 18 months vaccines. It took the students two months to complete the audits for all nine of us, and to enter everything in the EMR. The total cost for the nine of us was $6,500: $4,500 for wages and $2,000 for printing, envelopes and stamps. We mailed 1,433 letters (out of a 12,000 patients roster in my group), so 12% of patients were overdue for one of those services. List maintenance and periodic mail-outs are going to be much easier now that we have the initial audit and computer entry done; our FHN admin person is going to look after this.

Plans are progressing for the big FHT office. A space planner came by my office: although about 15 t FHT physicians will be located there, each group will have their own individual practice space within the large office. Several of the FHT nurses, dieticians, social workers, as well as the FHT admin staff will be also be located there. I have been thinking about how I would like to work; my partner can't move to the big office since he's not part of the FHT, and isn't computerized. I think I would be happiest in a group practice, with two other colleagues. It is time for me to take on some new associates; I will be asking my FHN colleagues for permission to add two new physicians.

There will be no filing cabinets.


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