There are many products that are available free to send, receive and view email through an internet browser. You have most likely heard of many of these mail services; gmail, hotmail, yahoo mail, etc. We all know and love these services that offer tons of free space to facilitate email communication. Signing up for these accounts is very easy and in minutes a user is established with an online email service. This works great for most people and there aren’t many complaints about free email.
There are however pitfalls associated to these services and any email service for that matter. How often do you find yourself spending 80% of your dedicated email time sifting through garbage, marking messages as spam and searching for legitimate messages in your inbox? People new to email can easily become overwhelmed by this information overload and give up all together. Many users set up an email account then pass out the address to their friends and think nothing of the matter. Then, later when the same user signs up for something on the internet they provide the email address again without question. How many times have you given out your address to some random web page which offers site memberships and maybe even newsletters? This blatant carefree use of an email address is what leads an inbox to become a daunting and scary cluttered mess.
The easiest way to combat this overbearing email onslaught is not as difficult as one may think. Add to the confusion and create a second email account. Actually a second email account can serve as a valuable tool with regard to mail organization and traffic management. A user can easily sign up for an alternative email account from another provider. This second account will allow a user to filter personal mail from mail that may be generated as a result of signing up with various websites. Let’s get rid of the trash. Sounds like a no brainer, right? A user now has a legit account, that she checks daily, and a second account that serves as a virtual trash bin. Checking this second account is as easy as logging in and deleting any messages that arrive. You don’t read that stuff anyway and if you did you would have provided your legitimate mail address in the first place. Pay special attention when giving out your mail addresses. Give out your main address sparingly use the second account for most everything else.
What if you also have an email account associated with work? There are a few options to consider when you have two or more accounts that you want to actively check manage. Mail forwarding is a way to funnel all messages to a single account where they can be then organized. Forwarding options are usually easily managed within the web mail account. Check the settings of your web mail account and look for these options. Forwarding can be a great way to merge personal accounts but these should always remain separate from business mail accounts. Many places of business prefer that employees utilize work mail for all communication within the organization. It is wise to treat work mail as a completely separate entity. Forwarding work mail to a personal web mail account can potentially lead to disaster at work. Imagine working in the health care industry, as I do, and mistakenly sending an email containing patient information to someone in your contact list who is not within your organization. This creates a HIPPA violation. This applies to companies who often utilize non-disclosure agreements as well. Protected company information should never be given to the wrong individuals. Therefore, eliminate the chance of this happening and keep personal and company email communication separate.
It is still very possible to manage work mail communication in a web browser environment. Many organizations allow users to access work email outside the company network. If this is a company wide practice you most likely received the logon instructions during your orientation process, if not ask your system administrator if web mail access is available. Outlook is widely used within the business world and works well with Microsoft Exchange Server, which is also commonly used. Exchange Server coordinates all company users’ email and Outlook allows users to create, read, save and send their messages. Many times, if Microsoft Exchange Server is being used, the web mail portions are also available. To check this, a user needs to know the company web URL (ex. www.somecompany.com), their domain name (ex. somedomain) and their personal username/password information. The domain name may need to be obtained from the system administrator but you can check for domain information through the properties window of “My Computer”. Look on the “Computer Name” tab for workgroup or domain name information. After you have gathered these pieces of information, open internet explorer and type the URL to the mail server into the address bar (ex. https://mail.somecompany.com/exchange). Notice the address settings add “https://mail.” before the company URL and “/exchange” at the end. This address points to the company network and the logon page dedicated to web mail. If this feature is enabled and the settings are default, users will see a logon screen where they must provide network user information such as domain, username and password. If this info is entered correctly the user will next see their mail inbox which looks much like the layout of Microsoft Outlook. Exact logon information should be obtained from your network administrator; your company may have changed from default settings.
Now you potentially have three web mail accounts; personal, business and trash. It becomes a task in itself to keep track of the passwords and logon information associated with this many mail accounts. The best way to organize this is to attempt to make the settings similar for each account. I like to try and use similar names and passwords, if not the same, whenever possible. I realize this creates a security issue but I am diligent about changing these passwords frequently. And frankly, I could care less if someone got into my junk trash account, maybe they will do me a favor and delete all that junk for me.
Finally, the efficiency of using these accounts can be maximized easily with one simple task. Place your mail icons where you can see and best use them. Instead of making icons on my desktop for each mail account and creating clutter, I prefer to shift this clutter to my internet browser. Internet Explorer 8 allows you to add favorite websites to a sub folder labeled “Favorites bar”. This will display convenient button links to pages within your favorites list. Use this list to your advantage. Place the logon pages of each of your mail accounts within this folder for web mail with true ease of use. Create easily located buttons for hotmail, yahoo mail, gmail and even one dedicated to you companies web mail logon page. There are many ways to optimize your use of web mail this article provides one approach that works very well for me.
Sunday, September 27, 2009
Thursday, September 24, 2009
Speed up your sluggish PC
Anyone who has put in any time on a PC has at some point experienced slow or unreliable performance. Web pages that take forever to load, poor application performance and excruciatingly slow download rates top the list as common problems for typical PC users. One reason for these annoyances, common users sometimes think the installation and use of anti-virus software (Norton, AVG, etc.) should solve these problems. In fact, these products serve as tools to diagnose and improve your system.
Human behavior is why these machines do not perform as we expect. Our behavior allows us to surf the internet for a few hours each night and completely overlook the task of ridding the system of unneeded garbage that results from this web usage. It’s like using your office every day and never emptying the waste basket.
In internet explorer, simply click tools then internet options. Next you will see options to set a home page, clear browsing history, delete browsing cookies and various other pieces of web information. It is these saved web settings that consume resources and can decrease performance. If you enjoy the luxury of your commonly viewed websites automatically filling in your log-in information for you each time you visit then you may want to save the cookies for this web page. However, saving cookie information involving passwords and user names provides an opportunity for your security to be compromised. It is best to delete this information. Temporary internet files and browsing history can also be eliminated without worry. Users can perform these delete actions at the end of each session or, better yet, automate these tasks with task manager.
Performance problems also come from the mere act of using your computer. Registry keys become created during program installation and many times are removed incorrectly, or not at all, when the program is no longer needed and uninstalled. Unused hardware is often disconnected. Many times the user forgets to remove the driver information, which holds dedicated space in the registry. This is yet another example of wasted resources due to registry errors. Finally, many spyware applications will reside within the registry. This can serve as a means to restore the rogue application with each reboot. That long pause during reboot may just be some dirty application forcing its way into virtual existence. These registry issues are just one way a system can suffer from decreased performance and they just scratch the surface.
Start-up applications can cause major issues and consume vast amounts of resources. Many instillations also include their programs within the start-up menu. This is sometimes a decent thing but what about things you would rather start yourself? Many users unknowingly have programs running all the time that they aren’t aware of and don’t use. These unused start-up applications just sit around, twiddling their thumbs, consuming resources like precious RAM. End this nonsense by clicking start then in the run box type msconfig and press enter. The subsequent window is used to configure system settings. The startup tab lists all items in the start-up list and checks the ones that start each time the computer boots up. Most times, many of these are not needed. Recognizable ones can be turned off without fear of harming the program itself, it merely needs manually started. Unfamiliar entries can be identified using google. This is a great way to detect harmful applications that run all the time. Check a few google results of each questionable program and harmful applications, if present, will quickly become apparent. Though unchecked from the start-up list any rogue program still needs to be removed, this is where registry optimization and virus removal tools should take over.
Clean up that hard drive, in more ways than one. Many computers are littered with applications that have been installed, used a few times then forgotten about. Sometimes, these icons even sit on the desktop as a constant reminder to the user that they still exists. Do you really still waste your cash playing partypoker or still use that cool aquarium screensaver? These applications need to go. If you want your computer to perform at the tasks (email, internet, word processing) you request of it then eliminate the unnecessary tasks (Screensavers, toolbars, games). Take a thorough look at add/remove programs and see what your system actually holds. Find applications you remember installing and determine if you still use it, if not, remove it. It is easy to determine questionable applications that you may be scared to delete, just google it. If you are still unsure leave it alone and deal with the things you recognize and have determined unneeded. Some of these questionable applications that you may be unsure of just might become apparent once compared to your search information on those shady start-up applications you researched using msconfig and the start-up tab.
Now we have eliminated logical data on our hard drive but what about the physical aspects? Upgrade is many times an option but it usually comes in exchange with a monetary obligation. An upgrade can, however, significantly increase the performance of a PC in the form of the physical connection type. Many aged systems only support hard drives which are connected by IDE cables, those wide grey cables you may have seen inside a PC. These cables connect the hard drive in what is known as a parallel connection. A more recent hard drive technology allows a hard drive to be connected serially through a considerably thinner cable. This serial connection has increased speed which delivers data to the system and information to the user in a more efficient manner. The thinner cable also promotes better air flow within the system case, which may squeak out a little more performance. If it’s an option and the funds are available, serially connected hard drives can provide significant performance boosts. Users will have to check the manuals for their motherboards or systems to determine if the physical connector is available within their system. Once again, google it!
Logical data storage on the disk may also become cluttered and spread throughout many places. When files are created, saved or changed they are saved on the disk in available space. This space is sometimes spread causing the file data to become separated while stored on the drive. If the space on the disk was optimized and data was moved and stored together the system could retrieve the information faster for the user. There are a few tools available to help out your poor old, disorganized, disk.
Disk clean up is a great tool to remove junk and unused files. Click start then my computer, next right-click on your hard drive and select properties. Finally, click the disk clean up button. This application will scan your drive for temporary installers, junk files, etc. and give you the opportunity to take out the trash.
Now that storage space is freed by removing programs and unneeded junk, it’s a good time to organize the data that is there. Disk defragmenter offers the perfect solution to your mess. Click start then double-click my computer. Right click your hard drive and select the tools tab then analyze. This application will analyze your drive and display valid information like disk consumption, size and estimated size after defragmentation. One click of the defragment button and you will soon see the visual representation of your drive during the defragment process. This could take some time so bring a book or flip on the TV.
These topics touch on a few methods that can be easily implemented to increase PC performance. Many other methods exist such as applications designed to automate these processes for users, expensive security application suites and upgrade parts. It is the users’ responsibility to realize when their PC has outlived its usefulness and has become overwhelmed by the intensity of the simplest web pages. It is at this point that no amount of maintenance and tune-up will ever help. Move on and buy a new PC.
Human behavior is why these machines do not perform as we expect. Our behavior allows us to surf the internet for a few hours each night and completely overlook the task of ridding the system of unneeded garbage that results from this web usage. It’s like using your office every day and never emptying the waste basket.
In internet explorer, simply click tools then internet options. Next you will see options to set a home page, clear browsing history, delete browsing cookies and various other pieces of web information. It is these saved web settings that consume resources and can decrease performance. If you enjoy the luxury of your commonly viewed websites automatically filling in your log-in information for you each time you visit then you may want to save the cookies for this web page. However, saving cookie information involving passwords and user names provides an opportunity for your security to be compromised. It is best to delete this information. Temporary internet files and browsing history can also be eliminated without worry. Users can perform these delete actions at the end of each session or, better yet, automate these tasks with task manager.
Performance problems also come from the mere act of using your computer. Registry keys become created during program installation and many times are removed incorrectly, or not at all, when the program is no longer needed and uninstalled. Unused hardware is often disconnected. Many times the user forgets to remove the driver information, which holds dedicated space in the registry. This is yet another example of wasted resources due to registry errors. Finally, many spyware applications will reside within the registry. This can serve as a means to restore the rogue application with each reboot. That long pause during reboot may just be some dirty application forcing its way into virtual existence. These registry issues are just one way a system can suffer from decreased performance and they just scratch the surface.
Start-up applications can cause major issues and consume vast amounts of resources. Many instillations also include their programs within the start-up menu. This is sometimes a decent thing but what about things you would rather start yourself? Many users unknowingly have programs running all the time that they aren’t aware of and don’t use. These unused start-up applications just sit around, twiddling their thumbs, consuming resources like precious RAM. End this nonsense by clicking start then in the run box type msconfig and press enter. The subsequent window is used to configure system settings. The startup tab lists all items in the start-up list and checks the ones that start each time the computer boots up. Most times, many of these are not needed. Recognizable ones can be turned off without fear of harming the program itself, it merely needs manually started. Unfamiliar entries can be identified using google. This is a great way to detect harmful applications that run all the time. Check a few google results of each questionable program and harmful applications, if present, will quickly become apparent. Though unchecked from the start-up list any rogue program still needs to be removed, this is where registry optimization and virus removal tools should take over.
Clean up that hard drive, in more ways than one. Many computers are littered with applications that have been installed, used a few times then forgotten about. Sometimes, these icons even sit on the desktop as a constant reminder to the user that they still exists. Do you really still waste your cash playing partypoker or still use that cool aquarium screensaver? These applications need to go. If you want your computer to perform at the tasks (email, internet, word processing) you request of it then eliminate the unnecessary tasks (Screensavers, toolbars, games). Take a thorough look at add/remove programs and see what your system actually holds. Find applications you remember installing and determine if you still use it, if not, remove it. It is easy to determine questionable applications that you may be scared to delete, just google it. If you are still unsure leave it alone and deal with the things you recognize and have determined unneeded. Some of these questionable applications that you may be unsure of just might become apparent once compared to your search information on those shady start-up applications you researched using msconfig and the start-up tab.
Now we have eliminated logical data on our hard drive but what about the physical aspects? Upgrade is many times an option but it usually comes in exchange with a monetary obligation. An upgrade can, however, significantly increase the performance of a PC in the form of the physical connection type. Many aged systems only support hard drives which are connected by IDE cables, those wide grey cables you may have seen inside a PC. These cables connect the hard drive in what is known as a parallel connection. A more recent hard drive technology allows a hard drive to be connected serially through a considerably thinner cable. This serial connection has increased speed which delivers data to the system and information to the user in a more efficient manner. The thinner cable also promotes better air flow within the system case, which may squeak out a little more performance. If it’s an option and the funds are available, serially connected hard drives can provide significant performance boosts. Users will have to check the manuals for their motherboards or systems to determine if the physical connector is available within their system. Once again, google it!
Logical data storage on the disk may also become cluttered and spread throughout many places. When files are created, saved or changed they are saved on the disk in available space. This space is sometimes spread causing the file data to become separated while stored on the drive. If the space on the disk was optimized and data was moved and stored together the system could retrieve the information faster for the user. There are a few tools available to help out your poor old, disorganized, disk.
Disk clean up is a great tool to remove junk and unused files. Click start then my computer, next right-click on your hard drive and select properties. Finally, click the disk clean up button. This application will scan your drive for temporary installers, junk files, etc. and give you the opportunity to take out the trash.
Now that storage space is freed by removing programs and unneeded junk, it’s a good time to organize the data that is there. Disk defragmenter offers the perfect solution to your mess. Click start then double-click my computer. Right click your hard drive and select the tools tab then analyze. This application will analyze your drive and display valid information like disk consumption, size and estimated size after defragmentation. One click of the defragment button and you will soon see the visual representation of your drive during the defragment process. This could take some time so bring a book or flip on the TV.
These topics touch on a few methods that can be easily implemented to increase PC performance. Many other methods exist such as applications designed to automate these processes for users, expensive security application suites and upgrade parts. It is the users’ responsibility to realize when their PC has outlived its usefulness and has become overwhelmed by the intensity of the simplest web pages. It is at this point that no amount of maintenance and tune-up will ever help. Move on and buy a new PC.
A study in electronic medical records for a community health center Part 3
How will this change the day to day work of the health center?
The introduction of a new system will change the way many staff members function day-to-day. It will be necessary to perform task assessments of each job function within the organization. This data will be used to outline the requirements of each job role. Once this analysis is complete members of management must then determine the needed job process within the new system. Many functions may change greatly but others may not change at all.
Each person in contact with the new system must be trained and comfortable navigating within the application. Thorough training sessions will be required for each job type. This training should be conducted by trainers provided by the application vendor, members of management and power users within the system. It is also very important to consider all input and concerns given by the end-users (Baum, 2006). This real-time information may prove key to future system configuration and honing.
An initial result of a new system is expected to be increased examination time allotment for providers (Groves, 2006). The responsibility of data entry will shift from the medical assistants to the actual providers. Providers will enter this data during examinations. This extra responsibility in itself adds some time to the allotted appointment. Also, as providers learn to use the new system exam time will increase. As providers become more familiar and comfortable with the system this exam time will decrease.
Who will benefit from this change?
Members of RCHC staff and patients will benefit from this system upgrade. Noticeable increases in productivity will not immediately occur. After the system has been in place for a few months members of staff will begin to notice improvements in how they are able to perform their jobs and monetary benefits will follow (Gonzalez, 2008). Unnecessary record organization and filing will become a thing of the past. Providers will see improved efficiency in the form of easily shared and attainable medical records and more complete patient files. Patients will also benefit from this digital and highly portable form of medical record archiving. As patients visit their provider and are referred to specialists their medical documentation will follow with no effort by the patient. Vaccination records, physical information, test results and allergy information will be at the fingertips of any provider a patient might visit.
Paperwork needed to attain a high level of patient care will be greatly reduced. System validation will also give staff member’s confidence in that they can be assured that the data they are entering into the system is accurate and complete. An electronic system also offers staff the opportunity to utilize and even increase computer related skills that can be a valuable asset.
Many members of medical staff are fearful of electronic medical records (Baharozian, 2004). This fear is not related to the use of the new system but related to the misconception that this system will possibly eliminate staff jobs. Clinical staff can view the addition of electronic records as cumbersome, difficult to use and creating more work for them in the long run. Members of management must be aware of these fears toward an electronic system and assure the clinical and office staff that there will be changes but they should not be viewed as threatening or difficult. These new systems do create many procedural changes but they do not serve to eliminate jobs or even make things difficult for clinical staff. After all, why would a health center implement a system that makes routine work procedures more difficult, this defeats the purpose of adding a new system? The best approach to reduce these fears and obtain staff buy-in is through staff involvement (Baum, 2006). When members of staff feel that they are part of the implementation and selection process they are more receptive to the change. Allow staff members to express concerns and ask questions about the system and attempt to answer these questions and address these concerns as promptly as possible.
System summaries
AllScripts
Small and mid-sized businesses can benefit from a proven solution known as AllScripts. All systems offered by AllScripts are expertly implemented, completely supported and easy to use. As a result, the implementation of this solution will streamline workflow; enhance the quality of care and an increase in the bottom-line performance through increased productivity. AllScripts electronic medical record system offers a vast library of built in knowledge for primary and specialty care, features such as patient portal and ePrescribing and is well regarded within the medical community. This solution can stand alone as an electronic medical record system with an interface to an existing practice management system or it can be purchased as an entire solution for seamless implementation and use (Allscripts, 2009).
Benefits of AllScripts
1. Ease of use
2. Strong return on investment
3. Higher quality care
4. Easy transition and training process
5. 24-hour support 365 days/year
6. Smoother workflow
7. Comprehensive knowledge base
8. Anytime access to critical patient and practice information
9. Enhanced patient wellness and patient care quality standards
10. Industry-leading interface capabilities (Conn, 2004)
11. Works in conjunction with existing practice management systems
NextGen
This solution is completely capable of serving the needs of Riggs Community Health Center by also increasing staff productivity and increasing the level of patient care. The electronic medical record portion of NextGen offers standardized documentation which ensures the quality and accuracy of the health care providers (Nextgen, 2009). NextGen also partners with hospitals and large health systems across the nation to improve patient safety through the interoperability of health information systems. Multiple systems can connect using NextGen electronic health records to share data. This sharing created a real-time electronic chart for each patient that can be viewed, appended and reported on with great ease.
Benefits of NextGen
1. Pre-built templates for increased workflow for over 25 specialties
2. Disease management templates
3. Integration with other products in the NextGen application suite
4. Instant access to documentation
5. Specially suited for multi-specialty practices
6. Ongoing support
GE Centricity
Centricity offers an electronic medical record system that enables providers and staff to document clinical information, streamline workflow and securely exchange clinical data with other providers and information systems. Centricity was designed by physicians with a focus on clinical ease-of-use. Centricity also integrates well with other systems such as revenue cycle application and practice management systems. This system was built with the information needs of providers in mind. This architecture allows for fluid streamlined patient visits, increased accuracy and completeness of documentation and enhanced patient care. Embedded clinical content and flexibility in encounter form generation makes this system completely dynamic and compatible for most any medical practice.
Benefits of GE Centricity (GE Healthcare, 2009)
1. Advanced reporting features
2. Macro creation for commonly used functions
3. Improved quality of care
4. Improved workflow management
5. NCQA certified for the diabetic physician recognition program
6. Concurrent user model facilitates real-time info needs
7. Voice-recognition
8. Community health center software configuration
Alliance of Chicago
In attempts to ease the introduction of a new system it is often necessary to request help from others. The most effective implementation will consider the failure and success of other organizations system implementation. It is beneficial to seek a consulting firm that specializes in electronic medical record implementation and support. The alliance of Chicago community health services is an organization that specializes in shared resources and service integration for community health centers (Alliance of Chicago, 2009). The Alliance of Chicago is a group of four community health centers based in the Chicago area that serve under-insured and non-insured patients much like RCHC. Each member of the Alliance of Chicago has systematically implemented electronic medical records within their practice. This experience has created a dynamic resource that can be utilized by any other community health center that wishes to also implement electronic medical records. This alliance specializes in the implementation of a system created by General Electric, titled Centricity. For this reason, GE Centricity is one viable option for RCHC.
Conclusion
Each of the proposed systems will facilitate effective practice management and electronic medical records. The purpose of this study was to evaluate three options and determine the best fit for Riggs Community Health Center. After careful evaluation and demonstration of each system, GE Centricity has been determined as the best fit for this organization. Centricity’s architecture, which is geared toward not-for profit community health centers, completely facilitates the use of a sliding fee scale; this factor alone makes this product stand out from the others. It has been determined that every need of this organization can be met through implementation and use of this product. The amount of support offered by the vendor is assurance that this system and the medical practice will suffer very little down time due to system error. Also, complete and prompt training will occur before, during and long after system implementation. This training will be facilitated through instructors provided by GE and project champions within RCHC. GE Centricity is also completely compatible with the current infrastructure. There will be very few pieces of equipment needed, beyond what is already implemented, to get this system up and running.
The alliance of Chicago will play an important role in the adoption of this system. As experienced consultants, the knowledge of this organization will provide an invaluable tool during preparation, implementation and continued support. The hard work, dedication and even the mistakes of the alliance will benefit RCHC. The Alliance of Chicago has performed this implementation many times and the members of this team know that ins and outs of this system (Rachman, 2009). This knowledge is of great importance to a small organization that cannot afford to learn from mistakes that could possible cost hundreds of thousands of dollars.
The introduction of a new system will change the way many staff members function day-to-day. It will be necessary to perform task assessments of each job function within the organization. This data will be used to outline the requirements of each job role. Once this analysis is complete members of management must then determine the needed job process within the new system. Many functions may change greatly but others may not change at all.
Each person in contact with the new system must be trained and comfortable navigating within the application. Thorough training sessions will be required for each job type. This training should be conducted by trainers provided by the application vendor, members of management and power users within the system. It is also very important to consider all input and concerns given by the end-users (Baum, 2006). This real-time information may prove key to future system configuration and honing.
An initial result of a new system is expected to be increased examination time allotment for providers (Groves, 2006). The responsibility of data entry will shift from the medical assistants to the actual providers. Providers will enter this data during examinations. This extra responsibility in itself adds some time to the allotted appointment. Also, as providers learn to use the new system exam time will increase. As providers become more familiar and comfortable with the system this exam time will decrease.
Who will benefit from this change?
Members of RCHC staff and patients will benefit from this system upgrade. Noticeable increases in productivity will not immediately occur. After the system has been in place for a few months members of staff will begin to notice improvements in how they are able to perform their jobs and monetary benefits will follow (Gonzalez, 2008). Unnecessary record organization and filing will become a thing of the past. Providers will see improved efficiency in the form of easily shared and attainable medical records and more complete patient files. Patients will also benefit from this digital and highly portable form of medical record archiving. As patients visit their provider and are referred to specialists their medical documentation will follow with no effort by the patient. Vaccination records, physical information, test results and allergy information will be at the fingertips of any provider a patient might visit.
Paperwork needed to attain a high level of patient care will be greatly reduced. System validation will also give staff member’s confidence in that they can be assured that the data they are entering into the system is accurate and complete. An electronic system also offers staff the opportunity to utilize and even increase computer related skills that can be a valuable asset.
Many members of medical staff are fearful of electronic medical records (Baharozian, 2004). This fear is not related to the use of the new system but related to the misconception that this system will possibly eliminate staff jobs. Clinical staff can view the addition of electronic records as cumbersome, difficult to use and creating more work for them in the long run. Members of management must be aware of these fears toward an electronic system and assure the clinical and office staff that there will be changes but they should not be viewed as threatening or difficult. These new systems do create many procedural changes but they do not serve to eliminate jobs or even make things difficult for clinical staff. After all, why would a health center implement a system that makes routine work procedures more difficult, this defeats the purpose of adding a new system? The best approach to reduce these fears and obtain staff buy-in is through staff involvement (Baum, 2006). When members of staff feel that they are part of the implementation and selection process they are more receptive to the change. Allow staff members to express concerns and ask questions about the system and attempt to answer these questions and address these concerns as promptly as possible.
System summaries
AllScripts
Small and mid-sized businesses can benefit from a proven solution known as AllScripts. All systems offered by AllScripts are expertly implemented, completely supported and easy to use. As a result, the implementation of this solution will streamline workflow; enhance the quality of care and an increase in the bottom-line performance through increased productivity. AllScripts electronic medical record system offers a vast library of built in knowledge for primary and specialty care, features such as patient portal and ePrescribing and is well regarded within the medical community. This solution can stand alone as an electronic medical record system with an interface to an existing practice management system or it can be purchased as an entire solution for seamless implementation and use (Allscripts, 2009).
Benefits of AllScripts
1. Ease of use
2. Strong return on investment
3. Higher quality care
4. Easy transition and training process
5. 24-hour support 365 days/year
6. Smoother workflow
7. Comprehensive knowledge base
8. Anytime access to critical patient and practice information
9. Enhanced patient wellness and patient care quality standards
10. Industry-leading interface capabilities (Conn, 2004)
11. Works in conjunction with existing practice management systems
NextGen
This solution is completely capable of serving the needs of Riggs Community Health Center by also increasing staff productivity and increasing the level of patient care. The electronic medical record portion of NextGen offers standardized documentation which ensures the quality and accuracy of the health care providers (Nextgen, 2009). NextGen also partners with hospitals and large health systems across the nation to improve patient safety through the interoperability of health information systems. Multiple systems can connect using NextGen electronic health records to share data. This sharing created a real-time electronic chart for each patient that can be viewed, appended and reported on with great ease.
Benefits of NextGen
1. Pre-built templates for increased workflow for over 25 specialties
2. Disease management templates
3. Integration with other products in the NextGen application suite
4. Instant access to documentation
5. Specially suited for multi-specialty practices
6. Ongoing support
GE Centricity
Centricity offers an electronic medical record system that enables providers and staff to document clinical information, streamline workflow and securely exchange clinical data with other providers and information systems. Centricity was designed by physicians with a focus on clinical ease-of-use. Centricity also integrates well with other systems such as revenue cycle application and practice management systems. This system was built with the information needs of providers in mind. This architecture allows for fluid streamlined patient visits, increased accuracy and completeness of documentation and enhanced patient care. Embedded clinical content and flexibility in encounter form generation makes this system completely dynamic and compatible for most any medical practice.
Benefits of GE Centricity (GE Healthcare, 2009)
1. Advanced reporting features
2. Macro creation for commonly used functions
3. Improved quality of care
4. Improved workflow management
5. NCQA certified for the diabetic physician recognition program
6. Concurrent user model facilitates real-time info needs
7. Voice-recognition
8. Community health center software configuration
Alliance of Chicago
In attempts to ease the introduction of a new system it is often necessary to request help from others. The most effective implementation will consider the failure and success of other organizations system implementation. It is beneficial to seek a consulting firm that specializes in electronic medical record implementation and support. The alliance of Chicago community health services is an organization that specializes in shared resources and service integration for community health centers (Alliance of Chicago, 2009). The Alliance of Chicago is a group of four community health centers based in the Chicago area that serve under-insured and non-insured patients much like RCHC. Each member of the Alliance of Chicago has systematically implemented electronic medical records within their practice. This experience has created a dynamic resource that can be utilized by any other community health center that wishes to also implement electronic medical records. This alliance specializes in the implementation of a system created by General Electric, titled Centricity. For this reason, GE Centricity is one viable option for RCHC.
Conclusion
Each of the proposed systems will facilitate effective practice management and electronic medical records. The purpose of this study was to evaluate three options and determine the best fit for Riggs Community Health Center. After careful evaluation and demonstration of each system, GE Centricity has been determined as the best fit for this organization. Centricity’s architecture, which is geared toward not-for profit community health centers, completely facilitates the use of a sliding fee scale; this factor alone makes this product stand out from the others. It has been determined that every need of this organization can be met through implementation and use of this product. The amount of support offered by the vendor is assurance that this system and the medical practice will suffer very little down time due to system error. Also, complete and prompt training will occur before, during and long after system implementation. This training will be facilitated through instructors provided by GE and project champions within RCHC. GE Centricity is also completely compatible with the current infrastructure. There will be very few pieces of equipment needed, beyond what is already implemented, to get this system up and running.
The alliance of Chicago will play an important role in the adoption of this system. As experienced consultants, the knowledge of this organization will provide an invaluable tool during preparation, implementation and continued support. The hard work, dedication and even the mistakes of the alliance will benefit RCHC. The Alliance of Chicago has performed this implementation many times and the members of this team know that ins and outs of this system (Rachman, 2009). This knowledge is of great importance to a small organization that cannot afford to learn from mistakes that could possible cost hundreds of thousands of dollars.
A study in electronic medical records for a community health center Part 2
Discussion of Issues
When selecting a system a medical practice should begin with planning and research. The goal is to identify a system that meets all the needs of the health center. Three important considerations when selecting a new system are a whether to utilize a single source provider or a hybrid developed from two vendors, application service provider or client-server model and finally a wired or wireless system.
RCHC already uses computerized billing but does not use electronic medical records. For this reason, it is important to consider whether to continue using the current electronic billing system or to purchase an entire package that combines electronic medical records and practice management. A solid argument for purchasing an entire solution from one vendor is the fact that the software will communicate more efficiently if designed by one company. Otherwise, special programming and database bridges will have to be created to facilitate the communication of the two systems. The term “integrated” is used to describe a system that incorporates practice management and electronic medical records in one application suite. When systems from multiple vendors are used they must be interfaced in order to transfer data from system to system. This interfacing of systems can be costly and time consuming and even create an opportunity for data loss or corruption during synchronization. Interfaced data transferred from the practice management system to the electronic medical record system consists of demographic information such as name, address and phone number. Data that travels only from the practice management system to the electronic medical record system is transferred using a one-way interface. In contrast, data that travels back to the practice management system is said to utilize a two-way interface. Data that travels back to the practice management system usually consists of billing information, diagnosis and procedure codes and general encounter information. This interface method can be a bottle neck for system problems. Any errors in coding can create a loss of data or data corruption during the data transfer process. For this reason many health centers choose to purchase an entire solution from one vendor, which decreases the chance that data is lost or corrupt while moving through the system.
A second solid argument for selecting an entire solution from one vendor is the perceived level of support that is provided by the product vendor. Technical support is often difficult to coordinate with even one vendor let alone multiple. It is much easier to troubleshoot a problem with one support help desk rather than trying to communicate with multiple help desks. In many cases, one company will state that a problem is related to another vendor’s product rather than theirs. This can lead to a wild goose chase just trying to determine the source of the problem. The last thing a member of medical staff wants to hear from a help desk is “that’s not our problem”. The best solution to technical problems with these systems is a staff member on-site that is familiar with the system and the hardware that is able to be a point of contact between the health center and the help desk of the application vendor.
Questions to consider (Hartley, 2007)
Is it time to change the current practice management system?
Many health centers have had great success with their practice management system and there may not be a need for replacement. If this is the case, it may be more practical to purchase only the electronic medical record system. Ultimately if the users of the system are happy with it there is no reason to change. If it is necessary to change, a convenient time to make the transition is with the introduction of the electronic medical record system.
The practice management system currently being used at RCHC is new but not completely effective. There have been many issues with the functionality of this application and the subsequent support. Basic data entry is often hindered due to sub-standard programming in the form of improper validation. This causes users to lose productivity trying to perform routine functions within the system. Problematic terminal server issues and printing configurations also cause lost productivity within the RCHC environment. The vendor of this product frequently makes programming changes and releases various service packs and patches in attempts to address these issues. More often than not, these changes create more problems within the system. It has become apparent that this particular vendor is supporting a product that has not been thoroughly tested in a real working environment. For this reason, RCHC has chosen to select an entirely new practice management system.
Does the current practice management system software company also make an electronic medical record system?
If a clinic utilizes a practice management system vendor that also offers electronic medical records it may be a wise decision to purchase the electronic medical record portion from the same vendor. This can save time and money during implementation and allow the users to work with a company that is already familiar.
RCHC’s current practice management vendor does offer an electronic medical record system. Due to past performance with the current system it has been determined that an entirely new vendor is necessary. There have been many support issues related to the current system. This particular product was released without proper testing and subsequent support is lacking. RCHC will have to cut its losses and choose a new system.
Is the electronic medical record system offered by the practice management software company satisfactory for this health center?
Many companies offer a complete software suite that facilitates practice management and electronic records. Some of these companies have created the electronic record portion of their suite long after the development of the practice management system. As a result, many software vendors have created an electronic medical record system on top of an antiquated practice management system. This type of patchwork can create a system that lacks features, is difficult to use and is built on obsolete technology. In a rush to enter the market, these companies have created systems that are released too soon and not designed to be the most efficient. This inefficiency can cause a health center to replace the entire system again once they realize the functionality is not up to par; this can be very costly and time consuming.
Can the health clinic use the existing network and computer hardware?
The existing network architecture is such that very few pieces of equipment will need to be purchased in order to implement a new system. The current system is composed of two terminal servers, two domain controllers, an exchange server, a report server, a print server and numerous workstations. This equipment can be used with almost any new system. Very few hardware purchases will need to be made for a transition to a new system. One technology that will need to be purchased for the health center is wireless connectivity. Providers will enter data directly into the system during the encounters. For this reason, providers will need access to the network within all exam rooms. The easiest way to achieve this connectivity will be wireless access points throughout the building (Gururajan, 2005). This wireless infrastructure will facilitate seamless connectivity regardless of the provider’s location within the building. This wireless connection will also require workstations that support wireless connectivity. Each provider will be given a mobile tablet PC to use during encounters in the exam rooms.
Questions to be answered
What are the organizations needs?
RCHC is a federally qualified health care center ant it serves members of the population who have very little or no medical insurance. For this reason, it is necessary to charge patients on a sliding fee scale as mandated by the federal government. Many practice management systems do not have or must make special accommodations for the sliding fee system. It will be necessary to include only practice management systems that do incorporate this scale.
The chosen system must function more reliably than the currently implemented system. Currently, many support issues go unchecked for many months and it is the responsibility of the vendor to address these issues. Application support must be ongoing and must not fade out shortly after the implementation (Ovretveit, 2007). It is often necessary to address practice management issues immediately in order to accommodate the patient. In these cases members of management at RCHC must have access to technical support at any time during the business day.
The selected system must function within a windows based environment. Much of the existing information technology hardware can be used for a new system. It would be costly and very wasteful to replace the currently implemented equipment. RCHC currently owns and manages a windows based network consisting of two domain controllers, two terminal servers, a Microsoft exchange server, a print server and a report server. This existing topology should support most all new practice management and electronic medical record systems with very little hardware upgrades.
What systems meet these needs?
Three systems will be evaluated and a selection will be made on the system that best fits the organization. Current providers and members of senior management have chosen to evaluate GE Centricity, AllScripts and NextGen.
When selecting a system a medical practice should begin with planning and research. The goal is to identify a system that meets all the needs of the health center. Three important considerations when selecting a new system are a whether to utilize a single source provider or a hybrid developed from two vendors, application service provider or client-server model and finally a wired or wireless system.
RCHC already uses computerized billing but does not use electronic medical records. For this reason, it is important to consider whether to continue using the current electronic billing system or to purchase an entire package that combines electronic medical records and practice management. A solid argument for purchasing an entire solution from one vendor is the fact that the software will communicate more efficiently if designed by one company. Otherwise, special programming and database bridges will have to be created to facilitate the communication of the two systems. The term “integrated” is used to describe a system that incorporates practice management and electronic medical records in one application suite. When systems from multiple vendors are used they must be interfaced in order to transfer data from system to system. This interfacing of systems can be costly and time consuming and even create an opportunity for data loss or corruption during synchronization. Interfaced data transferred from the practice management system to the electronic medical record system consists of demographic information such as name, address and phone number. Data that travels only from the practice management system to the electronic medical record system is transferred using a one-way interface. In contrast, data that travels back to the practice management system is said to utilize a two-way interface. Data that travels back to the practice management system usually consists of billing information, diagnosis and procedure codes and general encounter information. This interface method can be a bottle neck for system problems. Any errors in coding can create a loss of data or data corruption during the data transfer process. For this reason many health centers choose to purchase an entire solution from one vendor, which decreases the chance that data is lost or corrupt while moving through the system.
A second solid argument for selecting an entire solution from one vendor is the perceived level of support that is provided by the product vendor. Technical support is often difficult to coordinate with even one vendor let alone multiple. It is much easier to troubleshoot a problem with one support help desk rather than trying to communicate with multiple help desks. In many cases, one company will state that a problem is related to another vendor’s product rather than theirs. This can lead to a wild goose chase just trying to determine the source of the problem. The last thing a member of medical staff wants to hear from a help desk is “that’s not our problem”. The best solution to technical problems with these systems is a staff member on-site that is familiar with the system and the hardware that is able to be a point of contact between the health center and the help desk of the application vendor.
Questions to consider (Hartley, 2007)
Is it time to change the current practice management system?
Many health centers have had great success with their practice management system and there may not be a need for replacement. If this is the case, it may be more practical to purchase only the electronic medical record system. Ultimately if the users of the system are happy with it there is no reason to change. If it is necessary to change, a convenient time to make the transition is with the introduction of the electronic medical record system.
The practice management system currently being used at RCHC is new but not completely effective. There have been many issues with the functionality of this application and the subsequent support. Basic data entry is often hindered due to sub-standard programming in the form of improper validation. This causes users to lose productivity trying to perform routine functions within the system. Problematic terminal server issues and printing configurations also cause lost productivity within the RCHC environment. The vendor of this product frequently makes programming changes and releases various service packs and patches in attempts to address these issues. More often than not, these changes create more problems within the system. It has become apparent that this particular vendor is supporting a product that has not been thoroughly tested in a real working environment. For this reason, RCHC has chosen to select an entirely new practice management system.
Does the current practice management system software company also make an electronic medical record system?
If a clinic utilizes a practice management system vendor that also offers electronic medical records it may be a wise decision to purchase the electronic medical record portion from the same vendor. This can save time and money during implementation and allow the users to work with a company that is already familiar.
RCHC’s current practice management vendor does offer an electronic medical record system. Due to past performance with the current system it has been determined that an entirely new vendor is necessary. There have been many support issues related to the current system. This particular product was released without proper testing and subsequent support is lacking. RCHC will have to cut its losses and choose a new system.
Is the electronic medical record system offered by the practice management software company satisfactory for this health center?
Many companies offer a complete software suite that facilitates practice management and electronic records. Some of these companies have created the electronic record portion of their suite long after the development of the practice management system. As a result, many software vendors have created an electronic medical record system on top of an antiquated practice management system. This type of patchwork can create a system that lacks features, is difficult to use and is built on obsolete technology. In a rush to enter the market, these companies have created systems that are released too soon and not designed to be the most efficient. This inefficiency can cause a health center to replace the entire system again once they realize the functionality is not up to par; this can be very costly and time consuming.
Can the health clinic use the existing network and computer hardware?
The existing network architecture is such that very few pieces of equipment will need to be purchased in order to implement a new system. The current system is composed of two terminal servers, two domain controllers, an exchange server, a report server, a print server and numerous workstations. This equipment can be used with almost any new system. Very few hardware purchases will need to be made for a transition to a new system. One technology that will need to be purchased for the health center is wireless connectivity. Providers will enter data directly into the system during the encounters. For this reason, providers will need access to the network within all exam rooms. The easiest way to achieve this connectivity will be wireless access points throughout the building (Gururajan, 2005). This wireless infrastructure will facilitate seamless connectivity regardless of the provider’s location within the building. This wireless connection will also require workstations that support wireless connectivity. Each provider will be given a mobile tablet PC to use during encounters in the exam rooms.
Questions to be answered
What are the organizations needs?
RCHC is a federally qualified health care center ant it serves members of the population who have very little or no medical insurance. For this reason, it is necessary to charge patients on a sliding fee scale as mandated by the federal government. Many practice management systems do not have or must make special accommodations for the sliding fee system. It will be necessary to include only practice management systems that do incorporate this scale.
The chosen system must function more reliably than the currently implemented system. Currently, many support issues go unchecked for many months and it is the responsibility of the vendor to address these issues. Application support must be ongoing and must not fade out shortly after the implementation (Ovretveit, 2007). It is often necessary to address practice management issues immediately in order to accommodate the patient. In these cases members of management at RCHC must have access to technical support at any time during the business day.
The selected system must function within a windows based environment. Much of the existing information technology hardware can be used for a new system. It would be costly and very wasteful to replace the currently implemented equipment. RCHC currently owns and manages a windows based network consisting of two domain controllers, two terminal servers, a Microsoft exchange server, a print server and a report server. This existing topology should support most all new practice management and electronic medical record systems with very little hardware upgrades.
What systems meet these needs?
Three systems will be evaluated and a selection will be made on the system that best fits the organization. Current providers and members of senior management have chosen to evaluate GE Centricity, AllScripts and NextGen.
A study in electronic medical records for a community health center Part 1
A Study in Electronic Medical Records part 1
Introduction
Information technology has profoundly changed the way many businesses operate. Data is now available at the click of a mouse button; this data can be used to compile valuable information for almost any industry. The shift to electronic data management creates many procedural changes for any organization (Back, 1995). The health care industry is no different and has been changed by the surge in information technology. The retrieval and manipulation of data, once performed with paper and pen, shifts to sophisticated database tables and management applications. A practice management system that includes electronic medical records is an automated clinical application that archives data which includes patient medical history, demographics, provider notes, drug information and even facilitates the issuance of electronic prescriptions (Surti, 2002). The implementation of a new system will create changes that require careful research and preparation before actual implementation. The selection and research process has begun at RCHC for a new practice management system that implements the use of electronic medical records.
Purpose of the study
This study identifies the obstacles associated with the research, selection and implementation of electronic medical records in a community health care environment. Thorough research is important in the selection of electronic medical records and is especially important when considering the needs of a federally qualified health center. Bad decisions can cost a health clinic hundreds of thousands of dollars in equipment and lost productivity and this money comes from tax payers in the form of federal grants such as the American recovery and reinvestment act of 2009, otherwise know as the economic stimulus plan (LeBlanc, 2009). The stimulus plan has allotted just over $500,000 for federally qualified health care centers for use in information technology and infrastructure (iHealthbeat, 2009). The goal of this study is to outline the steps needed to effectively implement a practice management system with the addition of an electronic medical records application with the least amount of wasted resources and time.
Significance to the writer
This study is significant to the writer and to anyone in the IT/medical industry. The trend within the industry is moving toward paperless offices and electronic records (Gates, 2007). This technology is not new but it is not yet widely used. Many staff members in the medical industry are not versed in technological lingo yet they still wish to utilize technology to the fullest. For this reason, it is necessary to employ staff members who are dedicated to technological advancement (Gates, 2007). These members of the staff can stay abreast to new systems and practices within the IT/medical community. Our near future will see an explosion of electronic medical record use and it is up to knowledgeable members of the staff to bring these technologies to light for the benefit of the business as a whole.
Significance of the study
The emergence of electronic medical record systems has created a rush by vendors who now offer over 300 systems for health care centers to select from (Venkatraman, 2008). This selection process can be cumbersome when trying to meet the specific needs of a clinic. For this reason, many clinics have formed consulting networks that aid other clinics through the entire process. A valuable resource to a health clinic can be provided by these networks of individuals who have already experienced this process and have already identified the pitfalls associated with this daunting task.
Many professionals in the medical industry are not trained or familiar with the level of technology required to perform this system implementation, this is why a consulting firm can be very useful (Jacobson, 2005). It is up to the technical support staff to understand and maintain any new system. Each member of management is required to be involved in this selection and implementation. Without everyone’s involvement this project could easily flounder under the extreme changes that a new system will bring. Each person in the organization will have direct contact with this new system and should be thoroughly trained and comfortable manipulating the new system. It is the responsibility of management to ensure that all users are able to properly use this system. Failure to properly use a new electronic medical record system can cause loss of productivity, security vulnerabilities and even unnecessary stress to members of the staff.
Significance to the health clinic
The implementation of an electronic medical record system should be well planned and well executed. The information within an electronic medical record system is too valuable and a practice is much too busy to take the implementation of a new system lightly. Loss of data and down time can be very costly to a practice. It is possible to purchase an excellent system but proceed with implementation in an ineffective manner causing many problems along the way. It is also possible to purchase an inferior system and have completely smooth implementation. The quality of the system is not an issue during implantation. A good implementation plan will keep the project manageable, not difficult or overwhelming.
Why should a medical facility consider the purchase of an electronic medical record system? The introduction of a new system, if implemented properly, can improve the organization bottom line, improve patient care and increase staff job satisfaction (Gonzalez, 2008). The organizational bottom line can be improved in many ways. First, the obvious cost of paper charts will be greatly reduced. Along with the reduction of paper charts comes a reduction in the number of staff members required to support a paper chart system. With the elimination of charts, staff members will spend less time faxing documents for quicker and easier digital transmission methods such as email. Costs related to organizing and storing paper charts will also be eliminated with the introduction of electronic medical records. An electronic record system will also decrease the time and cost associated with medical transcription.
Significance to the patients
Patient care will be increased with the addition of electronic medical records. The elimination of the gap in time currently required to enter encounter data into the system will decrease possible documentation errors. Missing or lost charts will be a thing of the past with all records accessible through a central database. An electronic medical record system will also bring issues to the forefront that may be currently overlooked such as patient allergies. It is easy to overlook things such as allergies and an electronic system will guarantee that these things are brought to the attention of providers during each encounter.
Organizational overview
RCHC operates without the use of any electronic medical records. Traditional charts and folders are used to record patient medical information. However, patient information does end up as data within the health center’s current practice management system. During the clinical encounter the information is gathered and recorded as hard copy on physical pieces of paper then placed within folders. The information from the folders is then entered in the current practice management system. This practice management system serves as an electronic database to store patient demographic, encounter and billing information. This system also automates the billing process and streamlines the practice scheduling for the entire health center.
The addition of electronic medical records to this system would expand the database to allow for complete digital records of patient medical information, not just demographic, billing and sometimes cryptic encounter information. The creation of physical patient folders and charts would now exist entirely within an electronic environment. Providers will be able to directly add information into the system during encounters decreasing data entry errors related to the delay in data entry. This new system will create procedural changes that affect the entire health center. A large portion of data entry time will occur within the exam rooms and in turn change the time required for an office visit, patient information will be shared with other providers electronically under HIPPA compliant methods and an entire medical records office and staff will be transformed. What once were a department consisting of two large rooms that stored rows of paper charts and a staff of five people, in time, will be a few computers and staff members integrated into the office environment.
Introduction
Information technology has profoundly changed the way many businesses operate. Data is now available at the click of a mouse button; this data can be used to compile valuable information for almost any industry. The shift to electronic data management creates many procedural changes for any organization (Back, 1995). The health care industry is no different and has been changed by the surge in information technology. The retrieval and manipulation of data, once performed with paper and pen, shifts to sophisticated database tables and management applications. A practice management system that includes electronic medical records is an automated clinical application that archives data which includes patient medical history, demographics, provider notes, drug information and even facilitates the issuance of electronic prescriptions (Surti, 2002). The implementation of a new system will create changes that require careful research and preparation before actual implementation. The selection and research process has begun at RCHC for a new practice management system that implements the use of electronic medical records.
Purpose of the study
This study identifies the obstacles associated with the research, selection and implementation of electronic medical records in a community health care environment. Thorough research is important in the selection of electronic medical records and is especially important when considering the needs of a federally qualified health center. Bad decisions can cost a health clinic hundreds of thousands of dollars in equipment and lost productivity and this money comes from tax payers in the form of federal grants such as the American recovery and reinvestment act of 2009, otherwise know as the economic stimulus plan (LeBlanc, 2009). The stimulus plan has allotted just over $500,000 for federally qualified health care centers for use in information technology and infrastructure (iHealthbeat, 2009). The goal of this study is to outline the steps needed to effectively implement a practice management system with the addition of an electronic medical records application with the least amount of wasted resources and time.
Significance to the writer
This study is significant to the writer and to anyone in the IT/medical industry. The trend within the industry is moving toward paperless offices and electronic records (Gates, 2007). This technology is not new but it is not yet widely used. Many staff members in the medical industry are not versed in technological lingo yet they still wish to utilize technology to the fullest. For this reason, it is necessary to employ staff members who are dedicated to technological advancement (Gates, 2007). These members of the staff can stay abreast to new systems and practices within the IT/medical community. Our near future will see an explosion of electronic medical record use and it is up to knowledgeable members of the staff to bring these technologies to light for the benefit of the business as a whole.
Significance of the study
The emergence of electronic medical record systems has created a rush by vendors who now offer over 300 systems for health care centers to select from (Venkatraman, 2008). This selection process can be cumbersome when trying to meet the specific needs of a clinic. For this reason, many clinics have formed consulting networks that aid other clinics through the entire process. A valuable resource to a health clinic can be provided by these networks of individuals who have already experienced this process and have already identified the pitfalls associated with this daunting task.
Many professionals in the medical industry are not trained or familiar with the level of technology required to perform this system implementation, this is why a consulting firm can be very useful (Jacobson, 2005). It is up to the technical support staff to understand and maintain any new system. Each member of management is required to be involved in this selection and implementation. Without everyone’s involvement this project could easily flounder under the extreme changes that a new system will bring. Each person in the organization will have direct contact with this new system and should be thoroughly trained and comfortable manipulating the new system. It is the responsibility of management to ensure that all users are able to properly use this system. Failure to properly use a new electronic medical record system can cause loss of productivity, security vulnerabilities and even unnecessary stress to members of the staff.
Significance to the health clinic
The implementation of an electronic medical record system should be well planned and well executed. The information within an electronic medical record system is too valuable and a practice is much too busy to take the implementation of a new system lightly. Loss of data and down time can be very costly to a practice. It is possible to purchase an excellent system but proceed with implementation in an ineffective manner causing many problems along the way. It is also possible to purchase an inferior system and have completely smooth implementation. The quality of the system is not an issue during implantation. A good implementation plan will keep the project manageable, not difficult or overwhelming.
Why should a medical facility consider the purchase of an electronic medical record system? The introduction of a new system, if implemented properly, can improve the organization bottom line, improve patient care and increase staff job satisfaction (Gonzalez, 2008). The organizational bottom line can be improved in many ways. First, the obvious cost of paper charts will be greatly reduced. Along with the reduction of paper charts comes a reduction in the number of staff members required to support a paper chart system. With the elimination of charts, staff members will spend less time faxing documents for quicker and easier digital transmission methods such as email. Costs related to organizing and storing paper charts will also be eliminated with the introduction of electronic medical records. An electronic record system will also decrease the time and cost associated with medical transcription.
Significance to the patients
Patient care will be increased with the addition of electronic medical records. The elimination of the gap in time currently required to enter encounter data into the system will decrease possible documentation errors. Missing or lost charts will be a thing of the past with all records accessible through a central database. An electronic medical record system will also bring issues to the forefront that may be currently overlooked such as patient allergies. It is easy to overlook things such as allergies and an electronic system will guarantee that these things are brought to the attention of providers during each encounter.
Organizational overview
RCHC operates without the use of any electronic medical records. Traditional charts and folders are used to record patient medical information. However, patient information does end up as data within the health center’s current practice management system. During the clinical encounter the information is gathered and recorded as hard copy on physical pieces of paper then placed within folders. The information from the folders is then entered in the current practice management system. This practice management system serves as an electronic database to store patient demographic, encounter and billing information. This system also automates the billing process and streamlines the practice scheduling for the entire health center.
The addition of electronic medical records to this system would expand the database to allow for complete digital records of patient medical information, not just demographic, billing and sometimes cryptic encounter information. The creation of physical patient folders and charts would now exist entirely within an electronic environment. Providers will be able to directly add information into the system during encounters decreasing data entry errors related to the delay in data entry. This new system will create procedural changes that affect the entire health center. A large portion of data entry time will occur within the exam rooms and in turn change the time required for an office visit, patient information will be shared with other providers electronically under HIPPA compliant methods and an entire medical records office and staff will be transformed. What once were a department consisting of two large rooms that stored rows of paper charts and a staff of five people, in time, will be a few computers and staff members integrated into the office environment.
Gateway MX3231 laptop revitalize
Job name = 001
Make = Gateway
Model = mx3231
PC/Laptop = Laptop
CPU = 1.5 GHz Intel Celeron M
RAM = 448 MB PC2-4200 DDR2 SODIMM 200pin Memory expandable to 1G/1 slot
HDD = 51.2 GB
Symptoms = Very slow boot time, around 5 minutes to load desktop. Immediate adware pop ups warning of virus infection. Pop up windows could not be closed. All options lead to further pop ups. Applications were disabled preventing proper scanning and virus detection. Windows explorer functions did not work. This prevented the salvage and movement of existing customer data.
DVD-ROM functionality was compromised due to the lack of resources caused by the pop up generating application. This rendered the DVD-ROM useless.
Start time 8:30 pm 9/22/09
Solution = Obtain all disks for this machine. These include XP disk + product key; Gateway OS re-install disk and a few various PC tools that are pretty much useless.
Infection prevented me from properly extracting files such as documents and images. I determined the best attempt a restoring this laptop to optimal performance was to completely wipe the HDD, partition and reinstall the OS. Good thing I have the Gateway OS install disk and a copy of XP sp2 with the product key provided by the owner.
First I tried the Gateway disk method. I powered down the laptop with the disk in the drive the powered the system back on. The disk ran through a few screens then threw an error regarding a missing windows file. I quickly scrapped the Gateway disk method and opted for the customary windows install with the good ole orange sticker.
Format a new partition and install windows on it and I’m in business, right? Well, there are still a few loose ends to tie up after this install. My first instinct tells me to check hardware that may not be working properly. Many people will rush to establish a network connection and install important OS updates. I’m working from a bottom up approach. I want to establish self contained functionality before I worry about the functionality of larger systems, such as wireless networking, internet connectivity and non-system applications. For this reason, I look to device manager for any hardware components that may be signaling issues.
Within device manager I notice that most devices are working properly. I do however notice five devices that display an “!” symbol within a yellow circle. This indicated that there is an issue with the particular piece of hardware and it should be addresses for the system to function at full capacity. In this case I notice an issue with the Ethernet controller, the mass storage controller, the multimedia controller, PCI simple communications controller and a VGA compatible video controller. The indications usually signify improperly installed or missing drivers. So my next logical step is to locate the drivers for this system, re-install, verify the fix and move on to bigger problems.
Past experience with laptops and desktops tells me that manufacturer websites usually provide a package that contains the drivers needed for new instillations. The leg work involves navigating the manufacturer website to determine the appropriate driver package to download and install. Since the customers PC is not yet connected to any network I will search for and download these files from an alternative laptop.
I obtained the network adapter and sound controller drivers and installed them manually then restarted the laptop. I noticed that this system threw a non systems disk error when the jump drive was plugged in and the system was booting up. I should check the boot order and move booting from USB lower on the priority list.
Network and sound driver install success. Also, and added bonus comes the wireless network drivers in the same step. Three more!’s to address then the hardware within the laptop in functioning properly. Instillation of these files from the C:\Cabs folder is strait forward when you use Start-> run -> c:\Cabs\then the part number. This path can easily be copied from the read me txt file and then pasted into the run command box.
After installing all the drivers recommended on the gateway support site all my !’s were gone. The system was good to go and nagging me to connect to the newly found wireless network. I next saved all the downloaded driver files to the recovery partition that was emptied due to corrupt and missing files.
The next step is to establish an internet connection and get the OS up to snuff. Off to find my wireless encryption code. Ah, luckily it was within arms reach.
Off to windows update and the needed updates are downloaded, installed and the pc restarts a few times then were all done. According to Microsoft they have done all they can for me without a monetary fee like “windows live one care”. One care is another product I would like to try further, I do enjoy the initial trial period. It’s a very long trial and the application runs very smooth on vista.
End Time 12:00 am 9/23/09
Hours Sub Total 3.5 Hours
Resume time 4:30pm 9/23/09
The next red flag is an indication from windows security center notifying me that I lack anti-virus protection. Since this is a laptop being fixed on a shoestring budget, I once again look to free services. My favorite free anti-virus software should be no surprise, AVG. I have been really happy with its performance and I almost always recommend it to my customers, which in turn leads me to also performing the instillation. This resource allows me to provide a valuable service to my consumers that serve as a gateway to more involved security applications. The instillation of AVG went as smooth as always and I no longer see that pesky windows notification, great. Were getting to the finish line but there are still a few more points of interest to consider before I am comfortable handing this unit back over to the owner with my stamp of approval.
There are millions of applications available that people download and use every day. There is a great number that are common and sometimes exist without the user knowing they are actually utilizing the application. Many of these programs come in the form of media players, text readers and applets.
A good place to start is adobe flash player to correctly display many popular web pages, adobe reader to view “.pdf” files and java runtime environment to facilitate common web applets. Caution; watch out for those automatically checked boxes that also install useless toolbars. I wonder how many shiny pennies adobe gets when some user accidentally forgets to un-click the box and installs the toolbar, just to un-install in ten minutes once he realizes. I installed flash, reader and java without a hitch.
My final touches include disk clean up, defragmentation and error checking. These functions take some time but I feel a sense of satisfaction when I hand over a system that I know has been thoroughly inspected for major and even minor problems that can cause the user anguish in the future.
Disk defragmentation and clean up took an exceptionally short time to complete. I have the fresh format/install to thank for that. With 85% of the drive free I’m home sailing, that is, after I pass the ever crucial physical disk consistency check, that is to check the disk itself for errors and bad sectors and fix them when possible. This check can make or break the projected dependability of a hard disk drive. I am confident that this particular hard drive will pass these tests with little issues. There has been no previous indication that there may be any issues related to physical devices such as hard disk drives and this has been confirmed by a lengthy but successful check.
I was given no specific detail on application that are a must have on this system so I estimated the household usage and prepared the system for that scenario. Any additional application should be left to the discretion of the owner. However, I am more than willing to provide my services in the instillation and configuration of such applications.
I know this family consists of users who have broadband access and use it for tasks such as internet surfing, emailing, online education, word processing and limited gaming. For this reason, I installed only applications that contributed to these functions. The obvious first selection was Microsoft office. This suite contributes to education, word processing and emailing. The owner of the lap top happened to have an unused educational copy of office 2007 with the product key. Since she is a student and paid for the application I saw no harm in installing it for her. This also allows other members in the family to use the software for educational needs and I knew that at least two others were also required to have this application but did not. Their only means of access to Microsoft office was at the completely unappealing computer labs at school. “Three birds with one application suite; can’t beat that”.
Next, I had to make sure the web browser supported the users’ demands. I know frequent online classes and homework submissions and taking place from this very laptop, I wanted to ensure that these encounters went smoothly. The first location to check is the browser itself. After windows updates, Internet Explorer 8 was installed. IE8 is a modern browser now on this aging machine. My common sense tells me that this browser may consume more resources. This is the opportunity to evaluate common system resources, determine their current levels and maybe increase them to add performance.
Additional RAM chips will usually add some performance to any laptop or PC that is not currently at its’ maximum capacity. Oddly enough this system is displaying 488MB of available RAM but the internal module is labeled 512MB. This is usually the case; RAM often comes in increments divisible by 8; such as 256, 512, and 1024. When in fact the actual storage capacity of a device may slightly vary. The listed maximum capacity of this system is listed as 1GB which will most likely be accomplished by a RAM chip listed with a capacity of 1024. I would recommend and facilitate the purchase of this upgrade. I feel this is a wise decision when trying to extend the life out of an already aging laptop.
My overall recommendations to this customer is to upgrade where possible, monitor anti-virus application in order to learn threats and defenses and maintain regular backups to safeguard important files and settings. I believe with follow up I can easily complete any applications instillations needed, configure this system for their home network and provide additional support for items such as printers, scanners and cameras.
Remaining problems= Three keys on the keyboard are previously broken, broken or missing. The “M” key was broken but not unusable. Salvaged parts from the completely broken “Space Bar” were used to repair the functionality of the “M” key. The pause/break key is completely missing leaving only the connective linkage used to bind the key and the board.
The overall condition of the keyboard on this system is of poor quality. Buildup beneath the keys which I have attempted to remove is preventing fluid motion while using the keypad. Also, the complete absence of the space bar leaves users scratching their heads in many situations; especially online. The damage to the keyboard and the incomplete functionality lead me to recommend a replacement keypad for this system if it is within their budget and available. Otherwise this system may become the slave to the ball and chain of an additional keyboard and pointing device, giving it a swift kick to the “mobile” genitals.
This system would benefit most with the addition of 1GB RAM. Increasing demands through applications and web pages will continue to challenge this laptop. Preparation comes in the form of upgrading the system to its complete potential in order to reduce any lack of system resources. Other upgrades such as video cards, processors can prove to be difficult and expensive. The most practical solution, RAM, is easily accomplished and usually provides significant results.
One final issue of note is moderate damage to the power cord used to charge the battery and run the system using a standard wall outlet. This damage appears to have been generated by an animal; like a small dog chewing on the wire. There are a few cuts in the coating and a few spots where significant amounts of metal wire are exposed and protruding from the coating. I would recommend the purchase of a new power cord/charger in the event that the damage somehow becomes significant enough to disable the system.
Conclusion= I am confident that this gateway laptop is performing at top condition considering the lack of upgrade. This performance can be sustained through constant anti-virus monitoring in conjunction with social networking experience on the part of the owner. A PC represents your personal workspace. It is important to know the space and know where to store your items. It is a delicate filing system that can easily become disorganized. Imagine leaving important papers all across your desk at home and in file cabinets at work and even a few at a friend’s house in his desk drawer. The same holds true for your PC a desktop, an internal hard drive and a network drive. They act in the same manner; various locations where YOUR files are located. Many home PCs, this one included, display chaotic file organization. Until users develop useful systems of organization within a digital office environment it remains difficult to understand the more complicated applications of personal PC use, maintenance and security.
End Time 9:30 pm 9/23/09
Hours Sub Total 5 Hours
Hours Total 8.5 Hours
Suggested upgrades
• Replace keyboard/Keys
• Upgrade Ram
• Replace power cord/charger
Make = Gateway
Model = mx3231
PC/Laptop = Laptop
CPU = 1.5 GHz Intel Celeron M
RAM = 448 MB PC2-4200 DDR2 SODIMM 200pin Memory expandable to 1G/1 slot
HDD = 51.2 GB
Symptoms = Very slow boot time, around 5 minutes to load desktop. Immediate adware pop ups warning of virus infection. Pop up windows could not be closed. All options lead to further pop ups. Applications were disabled preventing proper scanning and virus detection. Windows explorer functions did not work. This prevented the salvage and movement of existing customer data.
DVD-ROM functionality was compromised due to the lack of resources caused by the pop up generating application. This rendered the DVD-ROM useless.
Start time 8:30 pm 9/22/09
Solution = Obtain all disks for this machine. These include XP disk + product key; Gateway OS re-install disk and a few various PC tools that are pretty much useless.
Infection prevented me from properly extracting files such as documents and images. I determined the best attempt a restoring this laptop to optimal performance was to completely wipe the HDD, partition and reinstall the OS. Good thing I have the Gateway OS install disk and a copy of XP sp2 with the product key provided by the owner.
First I tried the Gateway disk method. I powered down the laptop with the disk in the drive the powered the system back on. The disk ran through a few screens then threw an error regarding a missing windows file. I quickly scrapped the Gateway disk method and opted for the customary windows install with the good ole orange sticker.
Format a new partition and install windows on it and I’m in business, right? Well, there are still a few loose ends to tie up after this install. My first instinct tells me to check hardware that may not be working properly. Many people will rush to establish a network connection and install important OS updates. I’m working from a bottom up approach. I want to establish self contained functionality before I worry about the functionality of larger systems, such as wireless networking, internet connectivity and non-system applications. For this reason, I look to device manager for any hardware components that may be signaling issues.
Within device manager I notice that most devices are working properly. I do however notice five devices that display an “!” symbol within a yellow circle. This indicated that there is an issue with the particular piece of hardware and it should be addresses for the system to function at full capacity. In this case I notice an issue with the Ethernet controller, the mass storage controller, the multimedia controller, PCI simple communications controller and a VGA compatible video controller. The indications usually signify improperly installed or missing drivers. So my next logical step is to locate the drivers for this system, re-install, verify the fix and move on to bigger problems.
Past experience with laptops and desktops tells me that manufacturer websites usually provide a package that contains the drivers needed for new instillations. The leg work involves navigating the manufacturer website to determine the appropriate driver package to download and install. Since the customers PC is not yet connected to any network I will search for and download these files from an alternative laptop.
I obtained the network adapter and sound controller drivers and installed them manually then restarted the laptop. I noticed that this system threw a non systems disk error when the jump drive was plugged in and the system was booting up. I should check the boot order and move booting from USB lower on the priority list.
Network and sound driver install success. Also, and added bonus comes the wireless network drivers in the same step. Three more!’s to address then the hardware within the laptop in functioning properly. Instillation of these files from the C:\Cabs folder is strait forward when you use Start-> run -> c:\Cabs\then the part number. This path can easily be copied from the read me txt file and then pasted into the run command box.
After installing all the drivers recommended on the gateway support site all my !’s were gone. The system was good to go and nagging me to connect to the newly found wireless network. I next saved all the downloaded driver files to the recovery partition that was emptied due to corrupt and missing files.
The next step is to establish an internet connection and get the OS up to snuff. Off to find my wireless encryption code. Ah, luckily it was within arms reach.
Off to windows update and the needed updates are downloaded, installed and the pc restarts a few times then were all done. According to Microsoft they have done all they can for me without a monetary fee like “windows live one care”. One care is another product I would like to try further, I do enjoy the initial trial period. It’s a very long trial and the application runs very smooth on vista.
End Time 12:00 am 9/23/09
Hours Sub Total 3.5 Hours
Resume time 4:30pm 9/23/09
The next red flag is an indication from windows security center notifying me that I lack anti-virus protection. Since this is a laptop being fixed on a shoestring budget, I once again look to free services. My favorite free anti-virus software should be no surprise, AVG. I have been really happy with its performance and I almost always recommend it to my customers, which in turn leads me to also performing the instillation. This resource allows me to provide a valuable service to my consumers that serve as a gateway to more involved security applications. The instillation of AVG went as smooth as always and I no longer see that pesky windows notification, great. Were getting to the finish line but there are still a few more points of interest to consider before I am comfortable handing this unit back over to the owner with my stamp of approval.
There are millions of applications available that people download and use every day. There is a great number that are common and sometimes exist without the user knowing they are actually utilizing the application. Many of these programs come in the form of media players, text readers and applets.
A good place to start is adobe flash player to correctly display many popular web pages, adobe reader to view “.pdf” files and java runtime environment to facilitate common web applets. Caution; watch out for those automatically checked boxes that also install useless toolbars. I wonder how many shiny pennies adobe gets when some user accidentally forgets to un-click the box and installs the toolbar, just to un-install in ten minutes once he realizes. I installed flash, reader and java without a hitch.
My final touches include disk clean up, defragmentation and error checking. These functions take some time but I feel a sense of satisfaction when I hand over a system that I know has been thoroughly inspected for major and even minor problems that can cause the user anguish in the future.
Disk defragmentation and clean up took an exceptionally short time to complete. I have the fresh format/install to thank for that. With 85% of the drive free I’m home sailing, that is, after I pass the ever crucial physical disk consistency check, that is to check the disk itself for errors and bad sectors and fix them when possible. This check can make or break the projected dependability of a hard disk drive. I am confident that this particular hard drive will pass these tests with little issues. There has been no previous indication that there may be any issues related to physical devices such as hard disk drives and this has been confirmed by a lengthy but successful check.
I was given no specific detail on application that are a must have on this system so I estimated the household usage and prepared the system for that scenario. Any additional application should be left to the discretion of the owner. However, I am more than willing to provide my services in the instillation and configuration of such applications.
I know this family consists of users who have broadband access and use it for tasks such as internet surfing, emailing, online education, word processing and limited gaming. For this reason, I installed only applications that contributed to these functions. The obvious first selection was Microsoft office. This suite contributes to education, word processing and emailing. The owner of the lap top happened to have an unused educational copy of office 2007 with the product key. Since she is a student and paid for the application I saw no harm in installing it for her. This also allows other members in the family to use the software for educational needs and I knew that at least two others were also required to have this application but did not. Their only means of access to Microsoft office was at the completely unappealing computer labs at school. “Three birds with one application suite; can’t beat that”.
Next, I had to make sure the web browser supported the users’ demands. I know frequent online classes and homework submissions and taking place from this very laptop, I wanted to ensure that these encounters went smoothly. The first location to check is the browser itself. After windows updates, Internet Explorer 8 was installed. IE8 is a modern browser now on this aging machine. My common sense tells me that this browser may consume more resources. This is the opportunity to evaluate common system resources, determine their current levels and maybe increase them to add performance.
Additional RAM chips will usually add some performance to any laptop or PC that is not currently at its’ maximum capacity. Oddly enough this system is displaying 488MB of available RAM but the internal module is labeled 512MB. This is usually the case; RAM often comes in increments divisible by 8; such as 256, 512, and 1024. When in fact the actual storage capacity of a device may slightly vary. The listed maximum capacity of this system is listed as 1GB which will most likely be accomplished by a RAM chip listed with a capacity of 1024. I would recommend and facilitate the purchase of this upgrade. I feel this is a wise decision when trying to extend the life out of an already aging laptop.
My overall recommendations to this customer is to upgrade where possible, monitor anti-virus application in order to learn threats and defenses and maintain regular backups to safeguard important files and settings. I believe with follow up I can easily complete any applications instillations needed, configure this system for their home network and provide additional support for items such as printers, scanners and cameras.
Remaining problems= Three keys on the keyboard are previously broken, broken or missing. The “M” key was broken but not unusable. Salvaged parts from the completely broken “Space Bar” were used to repair the functionality of the “M” key. The pause/break key is completely missing leaving only the connective linkage used to bind the key and the board.
The overall condition of the keyboard on this system is of poor quality. Buildup beneath the keys which I have attempted to remove is preventing fluid motion while using the keypad. Also, the complete absence of the space bar leaves users scratching their heads in many situations; especially online. The damage to the keyboard and the incomplete functionality lead me to recommend a replacement keypad for this system if it is within their budget and available. Otherwise this system may become the slave to the ball and chain of an additional keyboard and pointing device, giving it a swift kick to the “mobile” genitals.
This system would benefit most with the addition of 1GB RAM. Increasing demands through applications and web pages will continue to challenge this laptop. Preparation comes in the form of upgrading the system to its complete potential in order to reduce any lack of system resources. Other upgrades such as video cards, processors can prove to be difficult and expensive. The most practical solution, RAM, is easily accomplished and usually provides significant results.
One final issue of note is moderate damage to the power cord used to charge the battery and run the system using a standard wall outlet. This damage appears to have been generated by an animal; like a small dog chewing on the wire. There are a few cuts in the coating and a few spots where significant amounts of metal wire are exposed and protruding from the coating. I would recommend the purchase of a new power cord/charger in the event that the damage somehow becomes significant enough to disable the system.
Conclusion= I am confident that this gateway laptop is performing at top condition considering the lack of upgrade. This performance can be sustained through constant anti-virus monitoring in conjunction with social networking experience on the part of the owner. A PC represents your personal workspace. It is important to know the space and know where to store your items. It is a delicate filing system that can easily become disorganized. Imagine leaving important papers all across your desk at home and in file cabinets at work and even a few at a friend’s house in his desk drawer. The same holds true for your PC a desktop, an internal hard drive and a network drive. They act in the same manner; various locations where YOUR files are located. Many home PCs, this one included, display chaotic file organization. Until users develop useful systems of organization within a digital office environment it remains difficult to understand the more complicated applications of personal PC use, maintenance and security.
End Time 9:30 pm 9/23/09
Hours Sub Total 5 Hours
Hours Total 8.5 Hours
Suggested upgrades
• Replace keyboard/Keys
• Upgrade Ram
• Replace power cord/charger
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