A Quick Diversion

I said in my last post I was going to continue to review EHR programs -  and I am, but first a quick diversion. One of my blog readers has asked a couple of good questions so I thought I'd answer them  here instead of in an email as some of you may have the same or similar questions. The first question is:

"How did you set-up client machines?" 

My EHR software runs off a Dell PowerEdge T310 Server. It has a Quad core Xenon processor with 8GB RAM and 1 TB of hard drive space in a RAID-5 configuration. I am running Windows Server 2008 R2 64 bit. This system meets or exceeds the requirements specified by my EHR company. Make sure you check with your EHR company for their requirements. Remember, the more powerful your server, the faster your entire system will run. I will get into other hardware specifics in a future post but suffice it to say, this machine is very nice.

I am running four hard-wired workstations using a gigabit ethernet switch and gigabit ethernet cards in each machine. I will go into more detail on the workstation configurations in a future post, but you can get a very nice workstation for under $600. At one station, I'm actually using a refurbished HP workstation that cost about $300. The four workstations are set-up like this: one workstation for my receptionist, one workstation for my biller, one for my nurse (just outside the treatment rooms in a private area we call the "lab") and one in my private office. I also have two laptops running wireless. One of these is a Fujitsu T580 convertible which allows me to use it as a tablet, (but I rarely do) and the other a Lenovo laptop. I have not yet wired systems into my three treatment rooms, as I prefer to carry the Toshiba with me from room to room. It is nice and small and works fine running on wireless-n. I use a Belkin wireless-n router with WPA security and it works great. I found a very nice and inexpensive cart to use in my treatment rooms for my Fujitsu convertible laptop:

I found it on eBay from the store HERE. I haven't seen it on his site lately, so if you are interested you should send him a message on eBay asking him about the Studio Designs Vision Mobile Desk/Laptop Glass Cart. It was under $100 including delivery. If you look at any of the "medical" laptop carts, they are as high as $700 - ridiculous.

Having been using my EHR for 1 year, I still am not comfortable using the laptop in front of a patient. I'm slowly changing, but for most patients, I still use a clipboard and paper to jot quick notes and then dictate my note into my EHR after the visit using Dragon. I have found it is quicker for me from a standpoint of patient flow and I am able to see more patients that way. I'm working on changing my work flow and may be singing a different tune by this time next year, we'll see. Therefore, at the present time I carry the Fujitsu T580 between the three treatment rooms. It's light and easy and works well for me. I also don't have to worry about kids banging on a keyboard or having to log-in and out of the EHR each time I go into a treatment room. As I become more comfortable with using the computer during a patient visit, I may decide to put a workstation in each room, we'll see.

Question #2:

"Have you gone to digital radiography and what system to you recommend?"

No, I have not gone to digital radiography, well I take that back, yes I have! It's not the digital radiography you think, but for me it works. I ran the numbers, and at the present time I can't justify the cost of a digital radiography system. I may change that in the next year or so, but I am happy with my current "digital" system. Here is what I do:

I take a regular x-ray and run it through my automatic processor. I can have bilateral AP and Oblique views out of my machine in under 5 minutes, which gives me just enough time to fit in a routine care, or follow-up visit while the patient who had the x-rays taken is catching-up on the latest gossip in this weeks People magazine. Then, either at the end of the day, or when I have a break, I put the x-rays on a view box in a darkened room and use my $120 Canon digital camera with macro feature, turn the flash off, and take pictures of the x-rays. I can then manipulate the images in the fantastic (and free) image editing program called Faststone Image Viewer  and then I import them into my EHR. So now I have both a hard copy x-ray that I store in an x-ray folder in a file cabinet (films take-up very little space) and I have an image to view in the patients electronic chart. Here is a video showing how I uses Faststone to adjust x-rays and images and add them to my EHR:

Yes, I know there are advantages to a true digital x-ray system, and if money were no object I would have one. But for now, this just works and works more than adequately. Check back with me in a year or two and see if I've changed my mind. Another way to go digital (although more expensive and more work) is to purchase an Epson V700 USB scanner with 8 x 10 transparency adapter ($539 on Newegg.com) to scan your x-rays. It will only work with an 8 x 10 film and scanning takes much more time than taking a digital photo, but I'd thought I'd mention it as it is an option. Also, if you are concerned about Dicom compliance, you can convert your .jpg digital photos of the x-rays to Dicom format using a couple of different programs. The first one is free and can be found here:  K-PACS Viewer. The second one will cost you about $189 and is available here: Power Dicom Basic Edition.

That's all for today's s post. I'll get back to reviewing EHR's soon. In the meantime, please feel free to ask me questions either as a comment here on the blog or by email at roger@podiatrysoftware.com. And thanks Andrew, for the great questions. ;-)