Home Forums Discussions General Discussion AC Migration and expansion advise

Currently using AC3 for scheduling only in peer mode with 5 wired PCs, 2 Providers, 4 MA's in Family Practice.
Planning to migrate to AC5 and implement all(many) of AC5 features along with related integrations. Would appreciate any advice on the following topics.

1. AC3 to AC5 migration, I plan to call support for help on this but would like to hear any warnings / considerations.

2. Trying to decide whether to have 2 roaming ( wireless ) laptops for providers or buy wired PC's in each of 5 exam rooms. Opinions?

3. Integration with Quest and LabCorp. Planing to have each of them install. any issues?

4. Phreesia for patient check-in. Is there an integration with AC5 or just save as PDF attachments?

5. Scanning old charts, do this by staff ( scanner recommendations ? ) or outsource ? Other related considerations ?

6. We currently use the AC offline backup service but don't like that you need to be an AC admin to do this. I want non-admin staff to do this or automate the process. Looking at USB drive plus Amazon S3 or other methods.

7. Dragon dictation, I see the threads that some use and like it. Anyone tried it and given up ?

8. Currently using XP Pro Dualcore 2G Ram for AC3 server and seems to work fine ( for scheduling only ) will migration to AC5 mandate an upgrade ? At what point do you need a "real" server ?

9. Tips for getting non-technical providers/users over the hurdle to utilize AC5 vs paper.

10. Incoming faxes, planning to save to PDF files instead of paper which the current Muratec fax/copier can do. Planing to have MA read and attach to patient records. Any other considerations ?

11. Based on the above is it realistic to do everything at once? If not is there a recommended order ?

12. Any mistakes made in the AC5 transition that are worth sharing so others can avoid the pain ?

Thanks for any inputs..

Unpaid, under appreciated husband / IT guy who hates getting support calls...

My opinions on some of the points:

2) We use wireless Dell laptops with good results and with docking stations in our offices. I take only short notes into the chart in the exam room, and use the full sized keyboard for the "heavy lifting". I have fat fingers. If I planned to do more in the exam room, a regular desktop keyboard and monitor would be better. Security would be more of a hassle.

3) Our IT guys set up integration with Quest. Once installed, it has been flawless.

5) See my post "Before you buy a scanner." As I said, I am giving you my opinions here. Take it or leave it as you see fit.

6) Check the thread "multiple backups, multiple places." It is long with a lot of geekspeak, but there was a whole lot of information imbedded there. I am perhaps the most data paranoid person the in world, and in the end I sleep soundly.

7) Dragon 10 is much better than 9. Better than my previous human dictation service which was running $1500 a month. Better than sliced bread.

9) Pizza. Lots of pizza, and flowers for the women. Encourage them to play with it before you go live. Reassurance that they will get it. Patience when they blow it. Reminder that if they want future employment in medicine they will need to know this or something like it sooner or later and better that they get it now when you are all learning. Lots of scheduled combined staff/provider meetings ( we started with 2X/wk at lunch, then down to 1/wk, now 5 months later every 2 weeks)

11) IMHO, it depends on what you have been doing. We came direct to V5 from another system that included electronic prescribing, dictating with Dragon into an electronic database, scheduling via our PMS and a variation of a patient portal. For us to not go backwards, we pretty much had to jump off the edge of a cliff and start using almost everything. It was very stressful. Maybe you can avoid that. Others here typically recommend you do so.

12. Unappreciated husband/IT guy, as the token male in our office and resident nerd I feel your pain. When we started I said in my loudest voice "I AM NOT GOING TO BE TECH SUPPORT FOR THIS." We hired some real IT folks, it cost a bunch of money, and it was worth its weight in gold to my sanity.

Again, as David said, this is just an opinion. 50% would say wireless, 50% wired. Make it 51% with my opinion for wired. If you can do wired, it is more secure, faster, and you won't have any dropped connections.

I have written several (probably over ten) posts on backups. You can download my talk from ACUC at link below. Amazon S3 is the best -- are you using Jungle Disk? Otherwise your backup plan (in my opinion) is not nearly good enough. You need far more local backups. You now currently have offsite and a moveable USB key. I would definitely recommend external hard drives.

You will never need a real server. That's right everyone....I said it. You really don't. I much prefer it, but P2P is fine. That is enough, but keep in mind that SQL Express will grab its 1GB of RAM rather quickly leaving you with 1GB left. It also depends if you are going to use that computer (not good IMO) If you can upgrade to 3 or 4GB of RAM, would be much better.

Show them a calendar. Make sure they see it is 2010. With NextGen or eMDs, etc. you would need some tips. With AC, it's rather straightforward.

Don't take this the wrong way, but I LOVE YOU! Where can I donate to the BHC Muratec MFP fund?

Do it all at once. Add RAM if possible. Install. Connect. And start practicing.

http://www.box.net/shared/static/6xom6be605.zip

It would be really helpful to use your real name rather than BocaHealthCare. You can use that as a nick, but if you go into your profile and set an auto-signature, it's easier for us to reply to you by your first name. Good luck. Welcome to AC.

The Access based AC3 was very easy to install. AC5 is fairly easy, but it would be a good idea to use support. That has to be schedueled I believe.
I vote for wired, but if it ain't broke, don't fix it. If your system is reliable you can run with it. I agree with Bert's comments.
Phreesia is only interested in getting money through credit cards. They have said they will have interconnectivity, but it does not. You have to download the patient info sheet. it is slow and not ready for prime time.
We purchased a high speed scanner and have been progressively doing this. There are a lot of ways to do this, however.
AC5 will do automatic backups. If your import items is large, which it will get with all the PDFs and such, you cannot upload them. there are other solutions you can explore.
I tried it, but templates work well for my practice so I rarely used it and have since replaced that computer. May be more useful depending on the practice.
That should do it, you can always upgrade later. Again, I agree with Bert, more memory is better, but 2 G will work well.
JUST DO IT
That should work. They will need to be signed off by the provider.
See number 9
Give yourself a weekend to get it all set up. Each machine will have to be set up separately. Initially we had some connection problems, they may have died down by now, that was in V4 the first SQL version.

Exactly!

Thanks Bert and David for the inputs.

Had my first step / hickup. SQL Express install failed to install as prereq to AC5. I now plan to make the old server a client and buy a new PC/Server is I need one anyway.

Lets see how far I get this weekend...

Good luck, Chris. Whether your particular road is smooth or bumpy, it does work out for everyone. Don't get discouraged.

And, thanks to Wendell, too. Don't forget him.

On the SQL installs, if there is an error message, please post ALL of it here. Take a look in your Add/Remove programs list and just make sure there is nothing SQL in there.

I use a tablet and take it with me room to room. I like it a lot ( also take it with me to the hospital) it has a microphone embedded in the frame which I use with Dragon Version 10. Makes charting soooo much easier than any of the old ways. BUT the back up batteries are expensive ( I think) and look to me like they are going to need replacement at about 18 months. I sometimes have to drag a power cord with me into the rooms ( Drag). I have 4 exam rooms and it seemed too expensive to hardwire a workstation in each of them, then I would need to use the hospital computers ( no dragon) or get a laptop anyway. Laptop it is. ( The ER at my hospital has scribes who follow the docs around, the scribes work off the same fujitsu tablet that I use.)

Thanks Wendell & Deborah, + Bert & David. I am impressed with the community support for AC. Makes me feel better about the decision for AC.

So I failed again to install SQL on my "server". Sorry Bert, I don't have the log in front of me but it indicated a fail at AppCompat. Anyway have a new 4G Quad Core W7Pro comming tomorrow. In the mean time I have installed a test version in Amazon EC2. I wonder if others have considered this vs buying a server? AC5 runs fine there but im not sure I'm ready to commit to the "Cloud" yet. What I am thinking now is that I will backup to S3 with Jungle disk and keep a server image of AC5 there as well in case my local server dies. Then I have a back up for data and a server ready to go.

So I am now testing from an iPad to AC5 in EC2, not sure this will work in every day use in patient rooms or not but it has potential.

Tomorrow is AC5 migration day if the new server works... This will be just for calendar at first ... not quite ready to "just do it" but getting the prereq's done.

Just my opinion, but I feel you are taking on far too much and being much too ambitious with using Amazon's Elastic Compute Cloud. To really utilize a real-time solution in a cloud environment, you will need a software solution such as Double-Take Cloud or FalconStore which can run from $4,000 to 10 times that.

While Jungle Disk backing up to Amazon S3 or Rackspace using deduplication techniques will allow you to have synced backups daily or however you backup, MY UNDERSTANDING is that this isn't going to be an image backup which you can simply change to in midstream if your server goes down. In fact, I know of few or none images backup programs which would allow one to utilize programs in the backup immediately without their being restored to the registry.

My recommendation would be to start within your office, e.g. set up your network with server or pseudoserver and your clients or wireless pads, etc. and then build from there. I would implore you to set up much more robust LOCAL backups augmented by offsite backups and take home backups whose main function is to make multiple backups of your data and less backups of your entire server. I would look more into your backup roles being to restore your data and not so much incredibly technical images in the clouds that may or may not run the way you want them when disaster strikes.

As to actually running AC in an EC2 environment, that sounds really cool, but you will need to look into the AMIs of both the OS and especially SQL and AC. Also, say AC is compatible, what about Medisoft or other programs.

Finally, the most important think is your inability to install SQL Server. It would be helpful to know if there were a number associated with the words. AppCompat is an error message, not the error itself, which usually indicates an incompatibility with your application and the OS -- not necessarily with its ability to run but its ability to install.

You may wish to install this small utility from Microsoft which cleans the install configuration of the app you are trying to install. You can always do a restore point previously. It can be found here:
http://www.softpedia.com/progDownload/Windows-Installer-CleanUp-Utility-Download-18442.html

Otherwise, Google the error message and install and SQL Express. Of course, if you are changing OS it probably doesn't matter. Most of the installation issues I have see have been due to unregistered .dlls, but that doesn't seem to be the error message you are running into.

Finally, make sure you are installing with Admin rights. Even if you are logged is as an admin, try right clicking and see if it allows you to "Run as"

So I got AC5 running on a new PC with some help from support. I was running the tuner from the web vs sl and running.
Regarding backup in S3 I was not thinking real time with image restore . Just jungle disk backup. You have convinced me to first do a local backup to external drive , then to S3 for offsite. I have a test version of AC5 running in EC2 with SQL express on the same AMI. I am thinking this still may be a decent backup server, the back up DB will be in S3 already. If the local server goes down the start up the AMI connect to DB and remote in as required.

Glad you got it working. Let me know how your EC2 works. Sounds rather cool.