Sunday, May 13, 2007

Having an IT administrator

Managing my office IT continues to require my time. One of my UPS (Uninterruptible Power Supply) devices failed. The computer crashed.

I called the company, and it turns out that the UPS device I bought can only handle one PC, and I had two PCs at the front connected to it. The voltage was too high. They sent me another UPS, and I connected it to the second PC; it works now. I phoned the company to pay for the second unit, but they won't accept that. I have to ship the other unit back, and then reorder a new unit. That makes no sense to me; I am not a travel agent for UPS devices. I'll just wait a bit and see if the company gets upset at me and allows me to pay for the second unit.

I have a bank branch downstairs at work. I wonder whose responsibility it is to deal with this type of issue there; I would bet that it is not the bank manager's. They also seem to have a huge amount of redundancy, certainly more than what I have. They probably have some very good remote IT support; do they have some in-branch support?

We probably need to think about the minimum level of redundancy in each practice; I have written about this before. Maybe we should have one admin person in each group (FHG, FHN, FHT) whose job it is to become familiar with each practice's IT set-up, and to deal with minor but annoying problems. These problems can become major very quickly if they are not dealt with; the physician is often the IT troubleshooter by default, but I don't think we are the best person for this. It would be good to have the IT administrator monitor each PC periodically to make sure that Windows updates are up to date, and that anti-virus programs are working and are scanning periodically. Computers should be restarted periodically. We were told to install IE 7 on every PC, which has not been done at my office. We should probably have the IT person develop some policies about routine PC maintenance.

I am looking at having a PC in the waiting room to let patients book their own appointments. I've noticed that this is a source of back-ups at the front; my secretary is on the phone, and patients are waiting to book their next appointments. The secretary does not know what time is good for the patient, and the patient can't see my schedule and does not know what times are available. This does not seem like the best booking method.

I've found out how to generate some numbers for my practice. I can generate clinical reports in html format, but this just gives me lists of patients (and not how many patients have a condition). I save these reports, and then open them up in Excel. I then use Data, Sort, and it gives me a number. For example:

All active pts in my practice age 20 and over: 987
code 278 (obesity): 226 pts (I code all BMIs of 30 and over as 278)
250 (diabetes): 95 pts
250 AND 278: 43

9.6% of my pts are diabetic
23% are obese
45% of diabetics are obese

Diabetics in my practice are more likely to be obese than non-diabetics.



Anonymous said...

Michelle, this is a significant problem in both small and larger physician practices. I had a similar situation a couple of years ago when a power supply in my server failed. Fortunately, I was sufficiently well prepared that I had an additional power supply on site (not exactly the same wattage, however I was able to open the server and install the power supply myself). It is still up and running 2 years later. However when the server shut down, there was a huge amount of panic in my office, including a backup of my patients in the waiting room, as I took the hour to install the power supply. Thankfully it worked. That was a horrible day. However it highlights the need for some technical expertise in-house (one of the physicians or staff) and a good IT support company or individual who clearly understands the setup and needs of that particular office.

Alan Brookstone

Michelle Greiver said...

Thanks, Alan. What worries me is the many offices without the in-house expertise. The majority of family physicians in Ontario are solo. The physician may not necessarily be able to be the in-house IT expert; the secretary may not either.

It takes time to fix problems; it takes less time if you know a bit about what you are doing. Phone support may not be enough if the physician is running behind; the problem may be left unfixed.

Perhaps a larger office is more likely to have in-house expertise, and redundancy to deal with problems as they occur; I don't really know.

I don't know what the answer is for small offices with "average" IT knowledge; I do know that what we have now is not enough. Just imagine your situation in the office of one of your colleagues who has no idea of how to open a server.

EMR companies are better at software support than hardware support. I have found that sometimes a knowledgeable university student can fix things for me.


Anonymous said...

A ton of interesting points here.

Isn't it great that a device that is suppose to support against failures (UPS) is what actually causes the failure? Always the irony of added redundancy.

I've always pointed out that having a reliable and quality technical person is important. Yes, I am biased since I'm a technical person, but it's amazing how much doctors want quality technical people. I don't actually want extra work since it takes me away from my family. However, when I do the work I charge huge amounts of money, because the doctors don't want to trust their server, network, etc to someone else. They are more than willing to pay a premium for someone they trust and someone who knows what they're doing.

As far as the normal updates, I've personally considered creating a monthly service for doctors that would do just what you described. Thanks for showing that this is a real need.

PCs in the waiting rooms are great. Our patients love it. We are now taking it to the next level where we capture all their initial paperwork including electronic signatures(like walmart). Certainly saves a lot of work for the front desk.

Those reports are awesome. You should really consider purchasing a version of Crystal reports. In most cases you can connect it right to your EMR and automate the reporting you just did. I think you'll be amazed at what Crystal Reports can do.