Tuesday, January 13, 2009

Adding more machines

My partner's tablet just spent a month in the shop getting fixed, as there were several things wrong with it (bit of a lemon). It came back after major transplants, and is now working well.

However, we were short 1 machine for a while. He took the Resident's tablet while his was away.

I had bought a very small computer for travel recently (the Acer Aspire). This machine costs $400, and runs Windows XP. During the past month, my RN and the residents used it (they don't need reading glasses). The nurse told me she likes the little machine better than the Toshiba laptop that was also available, as the Acer is much more portable. I found it somewhat surprising that something so small (and inexpensive) was actually useful; the EMR actually runs well on it.

I did not add MS Office to the Acer, as I don't need it; I downloaded OpenOffice, which is free and runs my word processing well.

We only use a fraction of the computing power on most of our machines, and most of what we use is repetitive. Much of the slowness in computers is due to adding new software (especially software that loads at start up and takes up a lot of memory), and not maintaining the hard drive. Hard drives need to be defragmented from time to time.

I don't like Vista all that much; I'm used to XP, and my network runs well with it. I'm not enough of a "techy" to be able to figure out the Vista-XP network problems (and I'm not that interested in doing it). The problem is that new computers have Vista on them. I'm going to need some additional computers for my new office, and I've been thinking of buying some good off-lease Dells, which are sold by several reputable companies. They're about $350 to $450 each. I'll put OpenOffice on the new machines.

The Family Health Team's Allied Health Professionals working in my practice all use the EMR now. The clinical pharmacist has been using it the longest and is very proficient. The dietitian uses it routinely. Our new Social Worker just started entering electronic notes; I sent her a message in the EMR, and was pleasantly surprised to receive a note back within two hours--she was logging in remotely.

What we had decided to do was to have everyone record things in the clinical notes instead of in separate areas of the chart. You can view a summary of the clinical notes which indicates which provider signed off, so it is easy to find the dietitian's notes if I need to review them. However, if a note is scanned in I'll see it because I have to review and sign it off. If something is written and signed off in clinical notes, I can't tell that there is a new entry and may not see it. What we decided to do is have our Allied Health Professionals send me a message in the EMR that there is a clinical note to review. So far, this seems to work well.

I now send a message within the EMR to our pharmacist that there is a patient to see her. As well, she now has her own schedule in my practice, along with "pharmacist appointment" that with a special colour. My staff is starting to book patients directly into her schedule. I think an e-message or direct booking are far superior to faxing a referral. I'd like to try this with the other members of our team.

I need to make sure that there are enough machines for everyone when they come in. On Fridays, the social worker and dietitian are in. My partner is in, as well as her resident; they need the Toshiba laptop and the Resident Tablet. I have an older Dell laptop in the office, as well as that new little ACER. However, if one of the machines goes down, we're now short. I just bought an off-lease Tablet for $700 (same machine as what I am using). We now have far more people in my office than when I started the EMR almost three years ago, and most machines are in use most of the time. It shows you that you really have to think about expansion when you start an EMR, and the investment in hardware does not stop; you can't see patients unless you have access to the record, and you can't have access to the record unless you have a computer.

Our fax machine bit the dust. My secretary bought a new one, a Brother MFC 7220. It came with some interesting sofware that makes faxing from the computer much easier: print the document, choose PC Fax and you have a single pop up to enter your fax number (or you can load your address book and choose a recipient from there). I can also fax from any computer on my network--the PC Fax software thinks it is a printer, and can be installed as a network printer. My staff were impressed, and I think they are going to start faxing straight from their PC very routinely. This even works over the wireless, so maybe I'll install it on the Tablets and laptops. New peripherals seem to be getting much better.

I think that eventually I'll have to replace all of my computers all at once. I'll plan for a new network then, and who knows what the technology will look like. In the meantime, what I have seems to be working.

Our residents have completed diabetic audits for six of my FHN colleagues, so now seven of us have results. 77% of the patients had data on BP, A1C and LDL within the past year available. Of those, 54% were at target for BP (<130/80), 38% had LDL <2, and 57% had A1C <7%. It is not bad, but we should figure out what happened to the 23% of patients with missing data; LDL is problematic, and we need to figure out how to improve those results.



Rene said...

Hooray for the openoffice use. Although lately I find myself using online doc editors like google docs or zoho most often.

John Lynn said...

Nice work on Open Office. Definitely a money saver and if everyone in the office is using it you'll have NO incompatibility problems.

However, the need to defrag is now a myth. This use to be useful when hard drives were small, but now they're big and defrag does very little these days to speed up computers. Buying as much RAM as possible, stopping useless processes and running a good adware/spyware program (see spybot, also free) will do the most to help speed.

I agree that the little computers are convenient and cheap these days. Plus, you can hook them up to a big monitor if you need to be stationary.

A fax server is an even more reliable alternative to the fax you describe. Essentially the same concept, but if you hook it up to Windows Server 2003 then the management of incoming and outgoing faxes is great. Definitely a big paper saver for an office that only costs about $50 to implement.

Michelle Greiver said...

Thanks, John

I have Windows XP, so I'm not sure if I can run the fax server you describe; it looks like it is programmed for Windows Server 2003.

I agree with your suggestions for adding more RAM (not expensive) when you buy PCs, and keeping most office PCs simple if possible. Not adding unnecessary programs (especially if they run in the background) is a really good idea.

Malware will slow down a computer. My IT guy recommends Malwarebytes, which I've used. A temp worker accessed a gaming site on one of my PCs (despite having signed the form forbidding this), and inadvertently installed a trojan; Symantec detected it, but it took Malwarebytes to remove it.