My tablet is now 3 1/2 years old; that's old for a computer! It is still working well, but I expect it to have an increasing number of problems over the next few months. It is time to get a new machine.
The other computers I initially bought are all desktops, and are functioning well; I bought pretty solid Dell business machines. These two computers are used at the front, and are limited to business functions only. One computer has the scanner and fax machine attached to it, and our IT manager added some extra memory a few months ago. I have a second scanner attached to a newer computer in the staff room, and a second fax machine in the staff room in case of failure--we have had to learn to plan for redundancy over the years. It looks like we can get a number of extra years out of the two computers at the front, although they will eventually fail and have to be replaced.
As we grew, I added more machines. I tried to keep the new PCs the same (all Dells, all Windows XP), so that maintenance would be easier (same look and feel, same software). There are now six desktops, four Tablets, three laptops and a Netbook in the office. We have two scanners, two fax machines, and four labelers. We have twelve printers; nobody has to walk very far to get a printed document. Everyone has ready access to computers. All this is for a (paperless) three physician office.
I talked to our IT manager before buying the new Tablet. I have to decide what operating system to buy (XP vs Windows 7), and which machine. I use the Tablet every single day; I decided to upgrade to as much RAM (4 MB) and to as fast a processor as they had available. I added three years of on-site warranty. My IT manager recommended that I downgrade to Windows XP, so that the machine would be fully compatible with the rest of my office network, and I have done this.
I will have to start thinking about what to do to upgrade the entire office, as our machines age. This is becoming a more complex issue due to the number of machines we have. My colleagues in our Family Health Organization will have the same issue, as we all bought our hardware at the same time. We should probably put this on the agenda at one of our IT committee meetings.
As you can see, we have more IT help and organization than when we first started. We have an IT committee, composed of two representatives from each of the two Family Health Organizations on our server and our IT manager. Our IT manager oversees the functioning and daily maintenance of our common server, and recommends server upgrades as needed. Because all FHO offices have similar hardware and software, our IT manager is able to provide some support for in-office issues over the phone (as he is now very familiar with what is in the offices), and we are experiencing far fewer hardware failures than in the first two years.
We are also starting to have a bit more IT structure for our Family Health Team (which is composed of six different Family Health Organizations). The FHT has an IT manager to oversee issues for the administrative office, as well as for the new FHT Allied Health clinical offices; this office was used for our H1N1 vaccination clinic, and is now slated to open later this month. It is two doors down from my office. There are a lot of computers there as well.
Last week, my eHealth Ontario internet connection was failing: it started to run more slowly, and would intermittently disconnect. The problem was isolated to the SOFA (Small Office Firewall Appliance), which is the router supplied by eHO. The SOFAs for all the practices here are now in the phone room of our floor, and the FHT's IT manager looks after problems for that equipment. He disconnected the malfunctioning SOFA and plugged my office into another office's SOFA as a temporary measure (worked well), and then notified eHO. They shipped another router by the next day, and we were back in business. Frankly, I like this managed approach much better than the old panic attacks at my office. Support makes a big difference; working as part of a larger group of practices helps; having an organization behind you is good.
We are starting to enlist the help of our patients. I received an email from a patient asking if we had a "preferred lab" in her area of the city. We are making a concerted effort to direct patients away from non-electronic labs: we have handouts on lab locations, and we call the patient if we get a lab result on paper (they get asked to avoid that facility in the future). A patient with a complex health condition said that she takes the printed CPP I give her to all the different specialists, because it helps them keep track of her overall health; she is very picky about making sure that I update the CPP properly, and we do this together. She can see that most of the specialists do not use computerized records. Another patient was furious about the fact that the hospital never sent me anything, despite the fact that she gave them directions to forward the information to her family doctor. She is going to complain to her Member of Parliament about the facility's lack of abilitiy to send her data electronically. Maybe we can partner with our patients to push for interconnectivity; after all, it is their health and their quality of care that is affected by the fact that their data does not follow them. Disconnected care is bad care.