Eliminate Print Servers: go LANless?
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@Jason said:
Most of the Healthcare providers around here use GE Centricity which provides a lot of the things you're asking for.
While we have one doctor who demands that everything be printed out, the rest are mostly willing to read what documentation is available in our own EHR. The biggest issue the other systems. In the past, before remote access other other records we had to have everything faxed to us. Today we have to go and get that information ourselves, but the only way we can get it is via printing (saving as a PDF), there is no way to electronically send it to our system for integration.
Direct messaging is working to solve this problem, but that seems to be slow going.
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@johnhooks - how do your doctor's office/clients deal with getting information from other offices?
We are a specialty clinic, we only see patients when they are having problems relating to that specialty. This means we need to get outside records all the time from sources all over the city, and more.
As I mentioned, we have one doc that just prints everything - why? Not entirely sure, thus far I haven't been allowed to ask that.
A piece of information I was given recently was the constant need to reference data from a previous visit (either in my clinic or somewhere else). This flipping is difficult at best, a huge pain in the ass at worst.
One thought was to give them a second computer/tablet where they can look at old chart data, while using the first for documenting.
A constant complaint I'm hearing is that the docs don't want to be typing in documentation while talking to the patients, it seems rude and impersonal.
What is your proposal to solving that?
Looking previous paper based methods, Doc walked out of a room, barked orders at a nurse, dictated into a dictaphone about orders, past medical history, etc. Those would take an average of 2 days to get transcribed. Now one of the trackable measures for Meaningful use is making available the office visit notes to the patient when they leave.
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@Dashrender said:
@johnhooks - how do your doctor's office/clients deal with getting information from other offices?
We are a specialty clinic, we only see patients when they are having problems relating to that specialty. This means we need to get outside records all the time from sources all over the city, and more.
As I mentioned, we have one doc that just prints everything - why? Not entirely sure, thus far I haven't been allowed to ask that.
A piece of information I was given recently was the constant need to reference data from a previous visit (either in my clinic or somewhere else). This flipping is difficult at best, a huge pain in the ass at worst.
One thought was to give them a second computer/tablet where they can look at old chart data, while using the first for documenting.
A constant complaint I'm hearing is that the docs don't want to be typing in documentation while talking to the patients, it seems rude and impersonal.
What is your proposal to solving that?
Looking previous paper based methods, Doc walked out of a room, barked orders at a nurse, dictated into a dictaphone about orders, past medical history, etc. Those would take an average of 2 days to get transcribed. Now one of the trackable measures for Meaningful use is making available the office visit notes to the patient when they leave.
Both offices I deal with are just PCP's. No specialists. Billing is outsourced (but I do know the billing department prints something whether that's PDF or paper I don't know). I don't see any paper flowing around, however I'm not there like you are. I'm only there if something is wrong. Your office size might be a factor also, I know you're bigger than we are.
As for the typing while talking with patients. The pediatrician we go to does that. I would be kind of concerned they wouldn't remember everything if they weren't. I don't find it rude at all.
All three doctors use Dragon and that crazy remote mouse/microphone for dictation after seeing the patient.
As for the previous visit data. If you're on Windows 10, can't you just use a virtual desktop or whatever Microsoft named it? If not on 10, can't you just do a side by side of two instances of the software? Is this on a laptop or at their desk?
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We have about half that use Dragon, most of them don't dictate while in front of the patient.
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@Dashrender said:
We have about half that use Dragon, most of them don't dictate while in front of the patient.
Ours don't dictate in front of patients but they will take notes.
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@Dashrender said:
@johnhooks said:
@Dashrender said:
I can say legacy or not...
There are three EHRs in play here.
Athenanet - ours
Epic - three of the major hospitals around here use it
Cerner - used by the other hospital systemYa that makes it tough, you probably can't get database access to pull info from the two others.
I can't get DB access to any, athenaNet is a cloud service.
You should never have DB access. The question is if you get API access.
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@Dashrender said:
A constant complaint I'm hearing is that the docs don't want to be typing in documentation while talking to the patients, it seems rude and impersonal.
What is your proposal to solving that?
Documenting patient needs isn't rude or impersonal, it is in fact their job, why the patient is there and as personal as can be. What could be more rude or impersonal than not taking every measure to provide the patient the best care by getting rapid, accurate data? If my doctor did anything else I'd find it rude, impersonal and unprofessional. This isn't a waitress competition to see who can memorize an order.
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@scottalanmiller said:
@Dashrender said:
@johnhooks said:
@Dashrender said:
I can say legacy or not...
There are three EHRs in play here.
Athenanet - ours
Epic - three of the major hospitals around here use it
Cerner - used by the other hospital systemYa that makes it tough, you probably can't get database access to pull info from the two others.
I can't get DB access to any, athenaNet is a cloud service.
You should never have DB access. The question is if you get API access.
Read only access via ODBC would be helpful so you could query. If it takes them this long to find info making their own reports from a query would help.
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@Dashrender said:
A constant complaint I'm hearing is that the docs don't want to be typing in documentation while talking to the patients, it seems rude and impersonal.
What is your proposal to solving that?
Replace the doctors?
That's a normal part of a doctor visit anywhere around here.
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@Jason said:
@Dashrender said:
A constant complaint I'm hearing is that the docs don't want to be typing in documentation while talking to the patients, it seems rude and impersonal.
What is your proposal to solving that?
Replace the doctors?
That's a normal part of a doctor visit anywhere
around here.FTFY
Definitely had doctors tracking all the info while dealing with out issues a week ago. Very careful record keeping "as it happened." That's as good bedside manner, personal service and patient care / non-rude as it gets. Now if the doctor was carefully recording the situation (video and audio recording in the patient care room for later transcription) maybe that would be okay, but how many patients want to be videod during a normal visit and there is a certain certainty in recording events as they happen because the recording itself can trigger the caregiver to think of details that they forget to clarify.
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@johnhooks said:
@scottalanmiller said:
@Dashrender said:
@johnhooks said:
@Dashrender said:
I can say legacy or not...
There are three EHRs in play here.
Athenanet - ours
Epic - three of the major hospitals around here use it
Cerner - used by the other hospital systemYa that makes it tough, you probably can't get database access to pull info from the two others.
I can't get DB access to any, athenaNet is a cloud service.
You should never have DB access. The question is if you get API access.
Read only access via ODBC would be helpful so you could query. If it takes them this long to find info making their own reports from a query would help.
no good system would allow that. API means that they control the queries. ODBC means you could be using inefficient queries and that you know database details that an end user should never know. ODBC is "under the hood" and while it works, it's an archaic way to handle this.
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@scottalanmiller said:
@johnhooks said:
@scottalanmiller said:
@Dashrender said:
@johnhooks said:
@Dashrender said:
I can say legacy or not...
There are three EHRs in play here.
Athenanet - ours
Epic - three of the major hospitals around here use it
Cerner - used by the other hospital systemYa that makes it tough, you probably can't get database access to pull info from the two others.
I can't get DB access to any, athenaNet is a cloud service.
You should never have DB access. The question is if you get API access.
Read only access via ODBC would be helpful so you could query. If it takes them this long to find info making their own reports from a query would help.
no good system would allow that. API means that they control the queries. ODBC means you could be using inefficient queries and that you know database details that an end user should never know. ODBC is "under the hood" and while it works, it's an archaic way to handle this.
Yes but if you're not a developer, who has the ability to spend possibly weeks learning their API and building an application to do this?
I can't believe that's archaic at all. It is still used all the time by tons of people.
End users aren't seeing any database details. You write the query and set the report up, they just type in a name and date or whatever info is required.
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@johnhooks said:
Yes but if you're not a developer, who has the ability to spend possibly weeks learning their API and building an application to do this?
.Should be the opposite. API should take less effort than having to code "under the hood" and learn their database and relationships and figure out what correct data is and isn't. ODBC means you have to do ALL the work rather than accepting the resulting data. For the reason you mention, ODBC has been replaced for two decades as how to handle these situations.
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@johnhooks said:
I can't believe that's archaic at all. It is still used all the time by tons of people.
So Windows 98 isn't archaic? You are actually saying that you don't believe that client/server programming isn't archaic? We were laughing any anyone doing this by the late 1990s. It's as archaic as it gets in IT. Unless maybe you are running this on your PDP-11.
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@johnhooks said:
End users aren't seeing any database details. You write the query and set the report up, they just type in a name and date or whatever info is required.
YOU are the end user here. This is not your database or your application.
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@scottalanmiller said:
@johnhooks said:
I can't believe that's archaic at all. It is still used all the time by tons of people.
So Windows 98 isn't archaic? You are actually saying that you don't believe that client/server programming isn't archaic? We were laughing any anyone doing this by the late 1990s. It's as archaic as it gets in IT. Unless maybe you are running this on your PDP-11.
Who was laughing at people doing this? You were laughing at people using a technology in the 90's that was newly developed in the 90's?
How is this https://developer.spotify.com/web-api/endpoint-reference/ any easier to learn than a database structure? And that's only for Artists, tracks, playlists, and profiles.
API should take less effort than having to code "under the hood" and learn their database and relationships and figure out what correct data is and isn't
There is no programming here. It's SQL query generation and then repeated with a report that spits out a PDF or whatever you want.
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@johnhooks this is more of Scott's fantasy island thing. I only argue with him on these silly statements when I am bored.
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The core of what is printed is information from the other systems that we have no APIs into. All we have is the ability to print the information, either to paper or PDF.
That information can be saved into the current EHR. The problem with this information is that it's non searchable at all, it's just an image. My EHR does not have any OCR ability with regards to these PDFs - they are just dumb pictures basically.
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@johnhooks said:
Who was laughing at people doing this? You were laughing at people using a technology in the 90's that was newly developed in the 90's?
Client / Server architecture goes back to the 1970s. It was already very old in the 1990s and widely known to be a major problem with security, safety, scalability, etc. Developers were laughing at people trying to implement things from decades past in new code.
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@johnhooks said:
How is this https://developer.spotify.com/web-api/endpoint-reference/ any easier to learn than a database structure? And that's only for Artists, tracks, playlists, and profiles.
That's failed logic. That you feel that "someone" has made a complicated API has no bearing or relevance to the fact that an API is the right way or easier potential way to work. The database behind that API could be any degree of complex that you do not anticipate as well. You are using the assumption of an easy database structure with a real world API. Even this isn't an example of an API that is harder, only an API you feel is hard. So it doesn't suggest that what you propose is true. At best it is an example of a bad API.
