Friday, January 12, 2007

Managing my hardware

I am starting to own a lot of hardware and software.

EMR is so important to my local residency program that preceptors are offered a subsidy if they buy a laptop for the use of medical students/residents. I just bought an extra Tablet. I am very happy with my Tablet, and I think it is a good idea for my resident to have access to one; it will likely be a very common form of medical data entry.

The new Tablet arrived recently. I then realised that I didn't know how to access my wireless network--it is not a simple home network, there are a lot of security features. That meant an email to the EMR company. I also had to put my printers on the Tablet (they are accessed wirelessly via IP ports), and I had to configure access to the server. This is a lot of work, so I ended up sending the Tablet to the helpdesk. They did tell me how to access my wireless, and I will keep this information.

One of my FHN colleagues has a folder with all the passwords, and a list of all the printers and computers in her office. This is a good idea, I think I will do the same. I think it is still better to have someone else do the work of setting up a new computer, but it is wise to keep all that information safe someplace. I probably know a bit too much about networking for my own good (that is, just enough to get into trouble); I know how to fix an IP port for a printer, because I've had printers change their IP address.

I think many offices will end up with at least one person very familiar with common IT problems, mostly through experience, so many things will be fixed quickly on site once the transition is over. I have an office manual, which is updated periodically; I have started to put EMR information in there, and I will add information on common problems. I think that, as we move towards a Family Health Team, or group practice, it would be good to assign one staff person to be a resource for the entire group; maybe we should give him or her a blackberry.

I have started taking digital photos to put in the EMR; I had an extra camera at home, which I brought to the office. The Tablet has a SD card slot, so I can just remove the memory chip from the camera and put it straight into the computer. I then attach the picture to the patient file.

Because I carry the Tablet with me all the time, it is becoming highly customized for my needs. I have found that I access some extra information within the EMR (example: templates), some on the internet (example: CDC travel advice), and some locally on my Tablet (example: "cheat notes" for common conditions). I have stopped using my PDA at the office, since I can access everything on the Internet; I use the on-line version of ePocrates. The PDA is backed up to the Tablet, so I have access to my phonebook and calendar on my desktop. I needed a Gestational calculator, so I downloaded one from Medical Algorithms and made a couple of changes, such as a field for "today's date", and changing from a standard Excel file to a template, so it can be reused. The Gestational template is at, click on Shared, and you will see the file to download. I have it in a folder on my desktop, and just save data for each pregnant patient as an Excel file in the folder; because of the "Today" field, the gestational age is automatically calculated when the patient is seen. I print the excel if referring a patient for prenatal care.

Finally, I have been told that some of my templates will now be shared with my colleagues. Once they are shared, I can no longer modify them. The templates include the age-based preventive health tables; this was the tables on paper records, and this is what they look like on EMR (click on preventive health in the shared folder; it is a big file because of all the screenshots, and will take about 20 secs to download). The last screenshot shows what the template looks like when saved to the patient record.

I bought a temperature logger for my fridge. My filing cabinets are now advertised on Craigslist.


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