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Tag Archives: Computers

Do Electronic Medical Records Affect Productivity – Part 2

In case you didn’t catch the earlier version of this experiment that I posted, you can find that one here. I work at several hospitals and each uses a different electronic medical record system. When I switch from hospital one to another, I obviously have my favorite EMR systems and my not so favorite EMR systems. In the previous post, I was using the EMPOWER charting system, which I liked for its simplicity, but disliked because of the layouts of the charting interface and some of the macros it contained. After becoming rather frustrated with the function of another EMR system, I decided to repeat the experiment at a different hospital. This hospital uses the Meditech system. I also did the same thing at a third hospital using yet another EMR. Those times will be published in a future post. I had to do the experiment at this hospital a few times because several times I wasn’t consistently busy throughout the shifts as I am at other places. In the shift that I used, I only tracked 7 hours in an 8 hour shift because the first hour had a lot of down time that wouldn’t have fairly represented the effects of the EMR on my productivity. In general, the whole shift had rather low acuity with only a couple of admits. In theory, low acuity should increase efficiency because of less charting time. It didn’t. In fact, the percentage of time that I spent with patients during this low acuity shift was just slightly more than the percentage of time I spent with patients during a much higher acuity shift which required more documentation of several more admits and a transfer. As with the previous experiment, when there was overlap, I would generally count the time toward the task with which I was focusing most — if I was speaking to a doctor on the phone while charting, I counted the time as only speaking to the doctor. Out of a total of 420 minutes, I calculated that I spent the following amount of time performing the following tasks: Seeing patients: 156 minutes Time on computer: 237 minutes including … –Charting/entering orders and labs to be done/entering discharge documentation: 191 minutes –Looking up old medical records: 20 minutes –Entering admit orders/completing transfer forms: 13 minutes –Meditech program issues: 13 minutes Discussions with other physicians: 20 minutes Miscellaneous down time (bathroom, food, non-work related issues): 7 minutes Despite a lower acuity shift, more than half of my time was spent on Meditech entering data. I should take that back. Thirteen minutes were wasted due to Meditech program freezes and due to watching the little hourglass turn over and over on the computer screen while Meditech’s pages loaded. The rest of the time was spent entering data. I lumped patient evaluations and re-evaluations into one category, so I wasn’t able to calculate the total time I spent with each patient. However, based on the numbers, it appears that time with patients averaged between 6 and 10 minutes (with a couple of outliers) Out of a seven hour shift, I spent just over 2.5 hours with my patients and their families and I spent just under 4 hours with the computer program. Sad.

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Cloud Computing

Cloud computing has a lot of benefits. By having your information stored on someone else’s servers and accessible online, you have access to that information anywhere that you have an internet connection. We are currently using Google Calendar for the scheduling of our group. It comes in handy because putting information onto the calendar is relatively simple and because we don’t have to send the schedule and all of the updates to everyone every time there is a schedule change. Updates are instantaneous and everyone in the group in addition to the hospital administrators have the address to the calendar, so all anyone has to do is check online to see the most recent version of the calendar. If you use Google Calendar for your personal events, you can easily integrate your home and work calendars which is also very handy for spotting conflicts and free time. Google Calendar also integrates with smart phones so that you can pull calendar updates to your phone as soon as they’re online. There’s one big problem with cloud computing, though. Someone else has the ultimate control of the data. If the storage owner takes the data offline or loses the data, you can’t get it back. In Google Calendar’s case, if you live your life on the cloud, you risk the chance of losing everything if the cloud vanishes. That’s just what happened to our group. I woke up one morning and found out that our clinic schedule was no longer available. I wrote to others in our group and no one else could access our calendar, either. Two years of schedules vanished. No one knew who was supposed to be working the following month. Google didn’t have a contact number for help correcting the issue. We wrote them several times at their designated contact page and got no response. So we had to try to reconstruct all of the information from old time sheets. Fortunately those are on our computers. See here for a two year old thread of 150+ comments discussing the issue of disappearing calendars with one lackluster response from Google. Many more “missing data” threads are on the site with very few responses from Google. I’m a little miffed about losing our schedules, but you get what you pay for. So the purpose of the post is to let your know that your cloud data isn’t always as “safe” as you think and to recommend that you back up your cloud data on a regular basis just in case the sun comes out and evaporates your information.

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Web Site Blocking

Some time yesterday morning, EP Monthly was labeled by Google as a site that could be spreading malicious software to its visitors. Those who visit this site may get a message something like that contained below. From what I can tell, it seems to happen more often with Mozilla Firefox than it does with Internet Explorer. I haven’t been able to recreate the problem with Opera’s browser, either. Thanks to everyone for e-mailing me about the problems. All I can say is that our programmer is on the case looking to resolve the issue as quickly as possible. As you can tell from this link, sometimes hidden code can be difficult to detect. To be safe, please make sure that all of your antivirus programs are up to date. If you don’t have an antivirus product installed on your computer and you use Microsoft Windows, Comodo and AVG both make excellent FREE antivirus suites. In addition, Microsoft put out a slew of security releases yesterday. Please use Windows Update in your start menu to protect yourself. Trouble with your browser? Try a different one such as Firefox, Opera, Maxathon, or SeaMonkey. We’ll get things back to normal as soon as possible. Oh, and if you people at Caremark, JCAHO or Press Ganey are behind this, you’re going to have to do a little better than this to shut me down.

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You Don't Own Your Software

An article I read in Wired Magazine kind of ticked me off, although technically I should be ticked at myself for not reading the fine print of the software I purchase. A recent ruling by the 9th Circuit Federal Court of Appeals says that software you purchase is subject to the license agreements contained with the software. Nothing new there. But if the license states that you may not resell or otherwise redistribute the software that you purchased, then you’re stuck with it. Up until this time, there was something called the “First Sale Doctrine” which states that one who purchases a copyrighted work may sell that copy without the copyright owner’s permission. Autodesk is a software manufacturer that produces a program called AutoCAD. The license agreement for AutoCAD states that the software may not be transferred or leased without Autodesk’s written consent. When an eBay member tried to sell a copy of Autodesk AutoCAD on eBay, Autodesk demanded that eBay remove the listing, which it did. When the seller then tried to re-list the software, his eBay account was terminated. The seller, Timothy Verner,  filed a lawsuit. The trial court held that the First Sale Doctrine applied. The Appellate Court reversed the trial court (.pdf), stating that someone who possesses a copy of a copyrighted work without owning it (such as a licensee) must abide by the license agreement and cannot transfer it to another person if the licensing agreement does not allow it. Some parties are now concerned that companies will start creating licensing agreements for all kinds of products – with strict rules of transfer. You can’t sell or give away books you’ve read. Could the sale of a car of home come with a license and licensing agreements in the future? This case reinforces the need to invest in free software and to encourage those who create free software. I’ve been using OpenOffice for almost a year now. The latest version is amazingly simple to use and deals very well with Microsoft Office documents. Companies that are still leasing Microsoft Office products are throwing their money away. I use GIMP instead of the Adobe Photoshop products. There might not be quite as many bells and whistles, but GIMP is still a comprehensive free product. If it weren’t for a couple of office programs that I use on a regular basis which are only available in Windows (document scanning and voice recognition), I’d switch all of my computers to the free Linux Ubuntu operation system. Almost all of Ubuntu’s programs are free as well. I still use Ubuntu on a regular basis, but switch back and forth with Windows depending on what I need to do. I’m currently experimenting with using Sun’s VirtualBox to run the programs inside of a Linux setup so I can dump Windows completely. There are links to large collections of free software in the “Other Useful Links” page I keep up in the right margin. Take a look at some of the programs. Many of them are similar to commercial products … and you don’t have to worry about being involved in litigation if you dare to transfer the program to someone else. Wonder if I can license blog posts …

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iPhone SpyPhone

I don’t use the iPhone and don’t want one, but for those who do use them … look at how much data it stores about you. This guy even teaches people how to recover information from the iPhone – including keystrokes, pictures, address book entries, call history, image maps, browser cache, and deleted voicemails. Moral of the story – if you plan to crank call the president, use a disposable phone.

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Virtual Operating Systems

Suppose you want to try out a new Windows program but you don’t want to mess up your registry. Or suppose you need Windows XP to run a program, but you don’t want to install Windows XP on your computer. What if you want to leave absolutely no traces of your computer activity? Or maybe you want to use a program but aren’t sure if it has a virus. There are a lot of uses for “sandboxing” operating systems or programs. Here are three free programs you can use to protect your computer. Microsoft Virtual PC is an updated version of a product that was initially introduced by Connectix. Virtual PC is a program that runs virtual hard discs on your computer. You create a virtual hard disk, then you install an operating system just as if you were installing the operating system on your regular computer. Once the system installation is complete, you can open a window and run an operating system within your operating system. I routinely run Windows XP (and even Windows 98) from my Windows 7 machine. You can choose the amount of disc space and memory to allocate to the program in the preferences. If you don’t want to save the changes to your virtual system, then you can just make a menu choice when you shut down the program and any changes will be discarded. Virtual PC is incorporated into Windows 7 Pro, but you can get almost the same functionality for no cost by downloading Virtual PC 2007. Sun VirtualBox works in a manner similar to Virtual PC with a few differences. First, VirtualBox is open source software. Virtual PC is proprietary (although still free to use). VirtualBox runs on Windows, Linux, Macintosh, and Solaris where Virtual PC only runs on Windows machines. Virtual Box commits all changes to the virtual operating system when you exit the system – you don’t have the choice to abort the changes like you do with Virtual PC. I get around this shortfall by making more than one copy of my virtual disk image and saving the “originals” in a zipped folder so they don’t get corrupted. VirtualBox also allows you to install more operating systems than Virtual PC – including Windows, DOS, Solaris, and OpenBSD where Virtual PC is limited to installing Windows (it is still possible to install Linux systems on the Virtual PC platform). Finally, Returnil Virtual System takes a little different approach to virtualization. Instead of creating a program window with a virtual system,Virtual System creates a clone of your current operating system and all of your activity takes place on this cloned system. If something happens and you want to erase the changes, you simply restart your computer and the system returns to the most recently-saved clone. Paid versions of Virtual System also allow you to save changes to your actual hard disk if you so choose. This system is a nice option if you want to see whether drivers will cause a problem with your current system configuration or if you want to try a program on your system without worrying about how the installation files will change your registry. I have used all three of these programs and they all work well. As is shown in the screen grab above, I can run Windows 7 on my base computer, Linux Ubuntu on one program and Windows XP on another program – all at the same time. All of the programs I have mentioned are available for free, although Virtual System also has several paid versions requiring yearly licensing fees from ...

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