You will start preparing your practice as soon as you’ve selected a vendor. At this time you will work with the vendor, project manager, consultants and IT professionals to purchase the appropriate hardware for the project and prepare your infrastructure for the EMR implementation.
Without the assistance of an IT professional, there is no guarantee the correct computer hardware has been purchased nor networked correctly. Yes, the software packaging will only identify the minimum computer hardware requirements. This is no answer to the real questions that arise during the user installation. A professional IT company is highly recommended for the integration and networking. When considering an IT company, always obtain a couple of bids to confirm the best deal for your practice. Finding a good IT company is similar to finding a good auto mechanic. The honest IT company will work hard to ensure your networking is correct and will stand behind their work. A dishonest IT company can run up excessive costs and are not likely to come back in the event of things not working well.
Selecting the right hardware technology for your office is critical to the success of your EMR implementation. With so many hardware options available on the market it can be difficult to find the right solution for your office. Which is better a workstation in each treatment room or a single Tablet PC that can be taken from treatment room to treatment room? When selecting this technology for your office, choose technology that is not overwhelming to your staff. Give your staff a chance to test this technology out to find out what they will be comfortable with and which technology compliments your office’s workflow.
Tablet PCs for EMR Software
These days Tablet PCs are the most popular choice for physicians as they provide physicians with an endless amount of information right at their finger tips. This translates into better patient care because the physician can access a more thorough patient record, access patient education databases, access medication databases to aid in prescription of medications, document at the point of encounter and send prescriptions/lab requests electronically using a more secure, less error prone method of transmission.
This is not to say that Tablet PCs are always the best choice. The technology has a number of drawbacks including limited battery life, cost, steep learning curves and being easily breakable. When selecting a Tablet PC you’ll need to consider which features are most important to you, here are some explanations of these features:
Which is better: Slate or Convertible style Tablet PCs? Tablet PCs come in 2 styles, the slate-style and the convertible-style. The primary difference is that the convertible-style comes equipped with a built-in keyboard while the slate style does not. Using a slate-style Tablet PC requires the user to use the stylus/digitizer pen as the primary user interface, as it has no option to use a keyboard. While the convertible still has full Tablet PC capabilities like hand-writing recognition, speech recognition and mobility, convertible-style Tablet PCs but tends to be thicker and heavier as their keyboard is simply extra weight when being used in Tablet PC mode; this weight difference is usually about 1-2 pounds. Some EMRs have deeper content than others making them more point n’ click friendly. These types of EMRs usually operate better on a slate style tablet pc as handwriting recognition and typing are needed less often. In most cases however the slate-style Tablet PC is a better choice as it is lighter (usually 3.5 lbs), easier to carry and offers more advanced features. However if you think you will be using the Tablet PC out of the office, or need to frequently use a keyboard the convertible is a more robust option.
What type of CPU is best for Tablet PC’s? Tablet PCs come equipped with two types of CPUs, the Intel Celeron and the Intel Centrino w/ Pentium M technology. While the Celeron is significantly less expensive, it lacks some of the important features that come with the Centrino including integrated wireless, faster performance, improved stability and advanced power-saving controls. The wireless chipset included with the Centrino platform are generally high-quality wireless cards that function in both 802.11b and 802.11g environments. In a physician office setting, heavy use of the wireless is expected so picking a Tablet PC with good wireless capabilities is very important.
How long is the battery life on a Tablet PC? Battery life ranges from 2 hours to 6 hours depending on the model. While many of the Tablet PC manufacturers claim to have higher battery life they often do not take into account how the Tablet PC is being used. For example, the built-in wireless networking can suck up a lot of battery life as do large applications such as Electronic Medical Records software. Even under these circumstances almost all Tablet PCs have a minimum battery life of 2 hours and some of the Tablet PCs by Motion (www.motioncomputing.com), HP (www.hp.com), Fujitsu (www.fujitsu.com) and Electrovaya (www.electrovaya.com) can achieve consistent battery life of over 3.5 hours while under heavy use.
Which Tablet PCs are best for use in physician offices? While there is no clear choice when it comes to purchasing a Tablet PC there are 3 models that have become very popular among physicians and are generally good choices. The new Motion LE1600 Tablet PC by Motion Computing and Fujitsu ST5000 Tablet PC by Fujitsu are arguably the best Slate-Style Tablet PCs on the market; both range between $2000-$2500. The Toshiba Portege is a great option as a convertible Tablet PC, as is the Lenovo X41 and HP tc4400. All 3 cost between $1500-$2000.
How do Tablet PCs connect to my network? All Tablet PCs these days come equipped with built-in wireless networking functionality. In order for a Tablet PC to send or receive data from your Electronic Medical Record software in real time you must be connected to a wireless network. For more information on wireless networking read the “Networking” section below.
For more information on our recommended Tablet PCs please visit out Tablet PC Showcase
Workstations
Workstations can be used in conjunction with Tablet PCs, Laptops or all on their own in each treatment room. Many offices choose workstations instead of Tablet PCs simply because it is a simpler technology, with less of a learning curve. Workstations are also a great option if an office has a large number of providers, but few treatment rooms as in this scenario an office is not required to equip each provider/assistant with a tablet pc or laptop but instead simply place 1 workstation in each treatment room. Workstations are almost always the choice system for front desk computers or where mobile computers are not required and/or cost is a concern as they usually priced well below $1000 each. Ultra Small Form Factor (USFF) workstations by manufacturers such as Dell and IBM are very popular options for offices with limited space.
Laptops
Laptops are a great low-cost solution commonly used for nurses and assistants who require limited mobility. These laptops are often placed on rolling carts which makes for convenient, mobile access while permitting the user to have their hands-free to work with patients. Laptops can be purchased for as little as $700 these days from reputable vendors such as Dell, Acer, HP and Gateway.
Servers
The server is the backbone for all your computers. If you are using software that operates under a client-server model you will be required to purchase a server for your office, if you don’t have one already that meets the vendors’ minimum requirements. Purchasing a server can be very complicated and prices can range from $2000 all the way up to tens of thousands of dollars.
The first step in the selection of a server is to find out what minimum requirements the software vendor has set forth. This will help get the process started. You will still need to make many decisions on other items, for example, which backup system you will use, what type of hard drive array, and which operating system.
Selecting a server with a hard drive RAID (Redundant Array of Independent Disks) array will protect your server from the very common event of hard drive failure. This is accomplished by your server writing the same data onto more than one hard drive simultaneously, so in the event that one hard drive crashes the other can take over with zero data loss. The two most common types of RAID arrays used in server for small organizations are RAID 1, RAID 5. Both provide hard drive redundancy but RAID 5 is faster and is easier to recover from in the event of a hard drive failure. It is also more expensive than RAID 1. RAID should be a minimum requirement for your server as hard drive failure is very common and RAID arrays are generally quite inexpensive, usually under $1000.
Deciding which operating system you’ll need for your server can be challenging. If your vendor requires MS SQL Server and your organization has fewer than 10 concurrent users then a server with Microsoft Small Business Server 2003 Premium Edition is usually your best bet. If you have more than 10 concurrent users you’ll likely want to purchase Microsoft Server Standard Edition and MS SQL Server separately as Microsoft requires you to purchase CALs (Client Licenses) for each concurrent user. Windows 2003 Small Business Server is more expensive if your office has a larger number of employees as each Client Access License (CAL) is more expensive than those of Windows 2003 Server. Some systems operate under UNIX or Linux servers. If your software is one of those, then it is usually best to consult your vendor or local IT company on what type of server you will need.
Imaging Devices
While we can never stop the paper from coming into the office, we can make the process of handling this incoming flow of paper as easy as possible. Fujitsu’s 4100 and 5100 models are the most commonly used scanners in the industry. Both have very small footprints and therefore can easily be placed directly beside a computer terminal located at a front desk. This will allow your staff to quickly scan in documentation such as intake forms, HIPAA forms, referral letters and insurance cards without having to leave their station. Multi function units (including. Printers and Faxes) are good options where limited scanning will be done and cost is a concern. High speed scanners handling over 25 PPM (Pages per minute) may be purchased or rented for the initial implementation phase where heavy scanning will be done.
Backup
Fact: Statistically 93% of companies that lost their data for 10 days or more due to a disaster filed for bankruptcy within one year. 50% of those same businesses that found themselves without data management for this same period of time filed for bankruptcy immediately. Source: National Archives & records Administration in Washington
In our own experience fewer than 50% of medical offices have a working backup system in place. By computerizing your patient’s medical and financial records you are increasing your dependency on computers. Total loss of your patient or financial records can easily ruin your business, legally and clinically. Putting the correct precautions in place is simple and does not need to be expensive. In addition to implementing a good backup system with recent copies being stored off-site, your backup should be tested on a monthly basis by simulating a full recovery from your backup image.
Do I want online backup or tape backup or both? Selecting the right backup system is very important. If you are using an ASP based system where the data is stored off-site, your vendor will usually take care of the backup for you. But if you are using a client-server system it is almost always your responsibility. Tape backup systems are the most common and usually cost less than $1000 for a complete system, assuming you aren’t backing up more than 100GB of data. Online backup services are becoming increasingly popular for the backup of patient data as it has the benefit of always keeping your data offsite, and protecting you in the event of a fire, server theft, hurricane, earthquake, flood and other natural disasters. While online backup could be your sole backup system, it is usually used in conjunction with a tape backup or hard drive backup system for redundancy. Don’t take backing up your system lightly, imagine the effect it would have on your practice if all your paper charts vanished from your office.
Networking
Your network is what connects all your computers together and enables them to access your EMR and connect to the internet. The type of software you purchase and the type of hardware you select will dictate what type of network you will need. If Tablet PCs, PDAs or laptops are going to be used, then you must plan on integrating a wireless network into your wired network. In order for these wireless devices to send or receive data from your Electronic Medical Record software in real time, you must be connected to a wireless network. To do this you, will need a Wireless Access Point which will enable you to connect the Tablet PC(s) wirelessly to your wired network. A high quality Wireless Access Point should be purchased as its proper functioning will be a major determining factor in how well your network performs. Business-quality access points from Cisco, 3COM, NetGear, Linksys are all good options and generally cost between $150 and $400
If you are using an ASP based system then you will need to plan on integrating a high quality internet connection into your network and enable access to the internet from each terminal. In most cases each terminal will need to have internet access as most software vendors will require it to provide technical support. If you are using a client-server based system and wish to have remote access to this system, then you will need to get an internet connection with a Static IP address.
Internet Access
Depending on if you are using an ASP or Client-Server based system will dictate which type of internet connection you will need. ASP based systems in most cases will require you to purchase a T1/T3 internet connection. These connections are faster than standard ADSL or Cable internet connections and are necessary due to the large amount of data that will be transmitted between your office and the remote location where your data is housed. For smaller offices, or for satellite offices that do not see a heavy volume of patients, a high end business DSL connection will often suffice. For offices using a Client-Server based system with limited remote access requirements, a business class DSL or cable connection will suffice. In all cases a Static IP will be required for remote access and technical support purposes.
Security
With internet and networks come new security risks. This is especially true for medical offices where patient data is at risk and security exploits can be very costly. Unfortunately the implementation of proper security measures is often overlooked. To help limit your risk of security exploitations be sure to hire the help of a trained IT professional with extensive experience in IT security. Both virus and Spyware protection should be implemented as a minimum security measure. Secure your network with a firewall to protect yourself from unwanted intruders on the internet. Manage client logins to protect your data from disgruntled employees (which is statistically the most common source of security breaches). If a wireless network is to be installed, it’s critical that the proper security measures have been put into place to protect from intruders accessing your wireless network from the area around your office, for example, your parking lot.
Tip: Buy only what is necessary for the beginning stages of the EMR implementation. You don’t know what technologies your staff will adopt and which they won’t. Don’t be in any rush to buy all the necessary hardware right off the bat.
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