NEW Geriatrics Practice including Nursing Homes

All the nursing homes have agreed to provide cable modem for high speed internet.

I am thinking of hardwiring the office with desktops for two reasons.
1. I have heard that a hardwired network functions faster than a wireless network
2. Desktops can be locally repaired on site whereas laptops and tablets have to be returned to the manufacturer. Individual providers can have their own laptop to take home for on call but the bulk of daily work can be done on a desktop. SOme have told me that Dell laptops are lasting only a year if they are being used for the whole day every day.

I know FP doctor has picket abletfactory - can their program run on a desktop?

NH

Nursing Home

nursnghome,

The OneNote EMR and OneNote Nurses Toolkit will run on desktops/laptops, however, when considered as part of our Toolkit strategy and other current products we really are focused on using specific Tablet functionality. In other words, our solutions are best suited for the solo doc, that wants to use their own forms/templates for encounter documentation with a Tablet PC.

Support is provided for "data interface" with some PMS/Billing solutions. Please feel free to email me if you need additional information.

Hope this helps,

Fritz

Some cursory thoughts...

You will probably be better off long-term with a "fat-client" arrangement, server computer(s) and desktop/laptop/tablet client(s) hosted within your physical office.

I concur about the hardwiring thoughts you mention, though you could save hardware $$, by not putting clients in the exam rooms, and using a wireless tablet (or, as I prefer, laptop as they are cheaper, have keyboard, and overall seem more reliable -- more like the desktop computer with which most of us are familiar) for room-to-room management. I use a CompuCaddy wheeled stand with this. (compucaddy.com)

Remote access, important with your setup, can be accomplished via Windows Terminal Server, which is built-in to Windows 2000 Server or 2003 Server. WTS is a program that permits you to remotely access your office. It is easy to use and great, because YOU ALREADY HAVE IT BUILT-IN. Basically you can "turn-on" WTS on your server computer, though a separate internet-connected and LAN-connected computer is ideal (and may be necessary depending on your software), via a toggle in the Add/Remove Windows Components section of the Add/Remove Programs of the Control Panel of Server 2000/2003. Microsoft lets you run it for free for 90 days, but you have to buy client access licenses thereafter. I recently ordered three licenses, which are setup as per user, not per session, if I understand correctly. (UNIT PRICE EXT. PRICE 79.52; MS MBL W2003 TERM CAL PER USER 238.56, per CDW)

On the client end, if the nursing home is using XP, go to Start-Programs-Accessories-Communications-Remote Desktop Connection. Punch in the static-IP address (you will need this to effectively and easily negotiate access to your WTS computer; often sold as a package by your ISP), and, "Voila," you are "in" your office. Typing with basic broadband is virtually as fast as if you were in the office. There can be some printing issues in these "thin client" type connections, which I circumvent by printing to my fax server (another MUST for your office) to the particular home. If you only have W2000 on the nursing home desktop, you can download Remote Desktop Connection from Microsoft (go to their downloads page) for free and then you're in business!

Another strategy is to use MS Small Business Server, a GREAT value for any small office IMHO. This has 2 administrative accounts built in, for remote access, without the formality of WTS (although I believe at one level they are the same entity).

One has to have a client application of your medical software on the box that has either WTS or SBS 2003, and there are other limitations. Still and all, this can be a great, reliable way to access your office remotely. Alot more to say, but too little time and space to address here.

One parting shot, I would STRONGLY consider, given the complexity of the patients with which you will be dealing and their spread-out nature, that you consider a deeper investment for your software. This harkens back to many a thread where cost vs value is argued. Just think long-term, and don't presume. You are talking about medical data here, YOUR medical data, and you need to know that the support and commitment of your company to address your many individual needs will be adequate. Take your time and think INVESTMENT, not EXPENSE.

All the best to you regardless,

NursingHome,

Considering the geographic distribution of your patients, you should look at Medtuity. It is a paperless solution and we have extensive experience in synch'ing from multiple facilities to a single central facility. Additionally, our "per-encounter" charge is your only charge. I have a strong feeling that multiple providers with multiple facilities will lead to a significant ramping of your costs with other vendors (and I hope they respond).

Thanks,

Matt Chase
www.medutity.com

I do a fair amount of nursing home work and use an internet connection with remote desktop to my server...no problem.

I think your real issues are ones that everyone faces which is what is the right software. My $.02 is to determine what excatly you want to accomplish now and in the future and find the software who offers the features that allow you to do that.

If it's SOAPware or AC, great. I agree with JCP in trying to think investment at least as much as expense. A vendor with good alerts can result in recouping your investment rather quickly.

Lowell

Dr. Quit, what EMR are you using? DOes it do the PM/Billing too?

Nursinghome,

Given that each nursing home will be providing
internet connection, and the information given
by Joseph, nearly any EMR you choose can be
hosted on your main office computer with the NP's
accessing the EMR via Remote Access.

Network: Hardwire vs Wireless
Pros and Cons of each. You will find most offices
now days are going for wireless. Atleast you have
the option to move your computers wherever you want.
Data input/retrieval in an EMR is just fine in a
wireless enviroment. Yes, "hardwire" is needed for
streaming video data which EMR's are not. You can find
the current discussion here on
Wireless Hardware. (I'm new at this too! )
http://www.emrupdate.com/forum/topic.asp?TOPIC_ID=3883

I would strongly recommend wireless networking in the
nursing homes too. And put a laptop on wheels. A good laptop
lasts much longer than a year ! I'm typing on a beater laptop
I bought 3 years ago I've used intensely day in and day out,
including occassional drops. I'm sure you've been reading
the "best tablet PC" thread. For me, I like to face the patient
when documenting. Here is what I'm looking to get for each
exam room to rest the tablet/notebood on while taking notes.
Also doubles as a mayo stand for small procedures. It would
easily allow me to sit and use it as a desk, facing the patient
at eye level. $69
I would put a nice nonslip desk protector on it.
http://www.dhmedical.com/ovtatidrme.html

(Other ideas here but don't give the Mayo Stand option
and not as easy to put your legs under the table top due to wheel bases.)
http://www.stacksandstacks.com/html/product411_0.htm


Enjoy choosing an EMR ! I really do like what I see coming
out of Soapware pending v5. I don't have any patients and am
starting in a month, so I'll be using Abletfactory as a stepping
stone. (BTW,Lowell uses Eclincialworks.com I like their total
integration with PMS, but find many newbiews have hidden complaints about not being intuitive as others requiring additional training.
Users are really liking their expensive ASP version $600/1st provider /month then discounted for other providers. Figure on $3,000 or so for training fees).
A lesser expensive ASP model is Aquifer costing
$180/month/provider at Solventus.com $2,160/year per user.


edit:
Amazing Charts demo
http://www.amazingcharts.com/moviedemos/OverviewLR.htm

I just did the demo again. And downloaded the software from
their website. This is an amazing piece of software for the
money. Yes, they are missing some things that are discussed
here on their thread, they are aware of those things and
making headway. You can use it for 3 months before deciding
to pay.

$999 for first provider
$200 for each additional provider
$250 yearly service and upgrades inclusive of all providers
$250 /year for daily backup of data inclusive of all providers

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