Using an EMR means having a lot of machines around.
I recently took stock of what we have. In an office of three family physicians, all part time (4 days a week, 3 days a week, and 2.5 days a week), we now own:
3 Tablet PCs
5 desktop PCs
Total: 9 computers in the office
As well, there are 8 laser printers, four label printers, and two scanners. There is a wireless transmitter, a Small Office firewall, two broadband internet routers (a main one and a backup), and a failover router. There is an external hard drive for storage, and an external DVD writer for larger scale back-ups.
Some of the printer are attached to desktops, others are network printers. The scanners act as photocopying machines and faxes; we also have a "regular" fax machine. We have several UPS devices in case of power failures.
On any given day, any of this can fail. My wireless has gone down, the internet access has failed, various computers have crashed, printers have disconnected, and labelers have printed little necklaces of labels with nonsense on them. I have learned to try for the best, and plan for the worst. Sometimes it feels like being in Samuel Shem's "House of God": the first thing I do in a crisis is take my own pulse--then I call my IT Guy.
Here is how I manage my PCs. All computers have anti-virus software, set to run scans on a weekly basis. I periodically defragment the computers, and check that Windows updates have been installed. Everyone has been taught to use "Winkey-L" to lock their workstations when they leave.
We run a small peer to peer network; I set this up to have shared documents on the front computer and external hard drive. My old charts have been scanned to the external drive, and then shredded. Those paper forms that the outside agencies simply won't give up have been scanned to the shared folder on the front computer; I made a copy on the external hard drive. Every PC can access all the printers that are likely to be useful at that station.
Much of my hardware was installed at the beginning; I added extra parts as needed-- some after a problem occurred. Whenever I added something new, there was always work to make sure it functioned properly; no hardware or sofware component ever works perfectly out of the box.
Looking at this, it does seem like a lot of work. However, much of what needs to be done (once installed) is simple maintenance, like a preventive health exam or taking the car in for a tune-up. This is still so new to small practices that we don't have good preventive routines yet; many physicians may not be all that computer literate, so machine failures get magnified because they can't be fixed quickly. I don't know how many of us have access to a good IT guy (instead of the neighbour's teenaged son); I know we didn't when my group started.
When things malfunction, the process of diagnosing computer problems is a bit like what we do for our patients. You try to figure out the likely cause of the problem by taking a history and formulating differential diagnoses, you run some tests, and then you try various things to fix the issue. The problem here is that this happens on top of patient care during a busy office, and the physician may be functioning at the level of a medical student in term of IT knowledge (especially at the beginning). I think it really helped us to function as a group so we could help each other out.
Interestingly, most of this hardware actually works pretty well, most of the time. Here are the things that can help: 1. do some preventive maintenance (antivirus etc) 2. have a good IT guy that you can call 3. buy good machines (not the cheapest ones) 4. keep all your CDs (drivers, software) in one place in case you need to find them 5. try to form a collaborative group with colleagues so you have someone you can call if you can't figure out what to do
And, if all fails, go and have a cappuccino--after all, these are just machines.