Home Forums Discussions General Discussion Using one AC with separate practices

Can anyone help me with a new concern that has come up in my clinic. I lease space to two other providers, (soon to be 4), we started using AC together and each paid for the licensing. We are all separate practices and bill separately using different TID and NPI's. We use AC as a group and all our patients info is in one AC account. My question is: should we all have separate AC systems and if we do, can AC separate the accounts and give us separate licenses?

I was told by outside provider that the way we are doing it now makes us collaborators and if one is sued then we all are sued.

I'm not an attorney, just a practicing solo physician. I can't really answer the legal question you raise. Do I understand correctly you are all sharing space but each has their own practice under a shared roof? If so you are each acting as separate offices. Your billing is already separate, and I think different practices should have separate EMR's.

AC support would probably have to address the matter of separating the accounts, and would definitely be a good resource on the licensing question.

Yes you understood correctly. Thanks for the answer I will contact AC tomorrow.

ggcnp,
Did you get this question answered? We are in the same situation - have two doctors with separate tax IDs in one office and they both want to use AC.
Serene

I think you need seperate licensing for sure. If you have a server that has virtulation built into it you could load a seperate instance of windows, creat a different domain or workgroup and load a new AC. Maybe export the data from the current AC and Import the cleaned up one to the new AC. I think this is what you are looking for

If you have two separate tax ID numbers, then you are two different practices, and you will require two different AC programs with licenss for each.

It would also seem like a logistical nightmare to have different practices in the same EMR not to mention HIPAA compliance. When I go to my doctor I expect her and those with a "need to know" in that office to know my health records. It would seem as though many patients would object to this setup even if they signed a release unless they are unaware of the situation.

I suppose if everyone covered for each other, then the confidentiality issue would be moot, but the licensing issue would still be a problem.

Yes, we're getting 2 licenses. We want to really have 2 versions of AC so only those who "need to know" will get into each physician's database. We don't want to mix the patient records in 1 database. I've been told by tech support to install the 2 main AC databases on 2 separate computers (the "server" computers). Then for the client workstations, we could reset the db path each time we want to switch between the databases. I was hoping there was a better way to do this. If not, we'll have to get another EMR program for one of the doctors.

Serene

Either way you have to buy something. No since it having a trainng curve

I guess I am still not completely certain what you are trying to accomplish, but, be that as it may, the recommendation by tech support is not a great solution at best and a catastrophe waiting to happen at worst.

If you are really trying to have each PC have the ability to access the other person's database, then the easiest way to do it, while not nearly as cheap, would be to install virtual machines on each computer and have two versions of AC running with each connected to a different database.

VMWare and Microsoft both have free versions, although I use the paid version of VMWare. What makes it a bit more expensive is you have to have licensed versions of Windows for each. But, once you had it running, you could keep it minimized and then just maximize it when you need to use the other database. You would want at least 2GB of RAM on each computer with a virtual machine as each would need its own RAM.

I work for a married couple - a general surgeon and a pediatrician. Their patients do not overlap. They share the office and staff only. Currently we use an old version of Lytec (1996 i think) to do billing, and we can open the program for both doctors at the same time. (Actually, it's the same Lytec.EXE installed in two different folders on the shared harddrive.)

There are 5 staff members including me. The rest of the staff work on the pediatric side. Only I have to access patient/billing records for both doctors. I'd like for it be similar to Lytec in that if I'm working on say, importing items into AC for the pediatric side and a patient calls to make an appointment with the surgeon, I can quickly open up AC pointing to his patient db to book the appointment. Will I be able to do this with virtualization? I'd prefer not to have two computers on my desk.

Serene

Another option is another inexpensive desktop computer and a KVM switch - 2 computers side by side but one monitor and keyboard/mouse - you can buy a second computer for around 300.00 and that you just hit a key combination and switch to the other computer. You can use VM as noted above - you might like having two computers - it is handy if one is a server (which you maintain, but do not use as a workstation) where you can be doing maintenance, etc and then hit keystroke and switch to your workstation without moving to another room, etc.

Serene,

Based on the fact that you are the only one needing access to the second instance of AC, Bert's suggestion of installing a Virtual Machine (VM) onto your machine and run the instance that you need access to on there is an excellent solution.

Your machine will need to be beefer than a minimal desktop to run the VM well, and memory is your friend. a 64bit OS will be of benefit as well.

Another thing to keep in mind is that you now have *two* different DBs to keep backed up.

The upside is that you can cut-paste from the same keyboard between systems as necessary, and you will probably find multiple monitors, or one large 23-26" monitor to be useful for working on both.

Indy, Steven,
Those are both good ideas. I didn't know about the KVM switch. I knew I could switch my monitor input but I thought I would have had to keep two sets of keyboard/mouse. The downside is having another computer to maintain...
Serene

In addition to the two virtualization programs that Bert mentioned above, there is a free program called Virtual Box. I have been using it for months without any issues, to allow 2 different users to be logged into AC on the same computer. I think it would work very well for your purpose as well.

I outlined how I set it up in this post.

John, that sounds like a great idea. I will have to try it. Thanks for the tutorial!

No, you can't. Actually, I say that because you can do more. You won'ty have to OPEN AC each time. It will already be open, and likely your VM machine will be minimized. When you maximize it or make it any size you want, it will be like you are in front of a whole different computer. And, you will be. It utilizes the "real" computer for hardware, etc. Even uses the CD, USB, etc.

Computing and networking is moving rapidly toward virtualization. At first, it will be hard to get your head around, but soon you will understand it completely. It allows you to network in a variety of ways, and when the next office opens, you just add an OS. But, you would then need more RAM. You can set how much RAM each VM gets, hard drive space, etc. If you make an error on the "real" computer, you must use a backup, etc. You should make backups of the VM, but it takes snapshots, and you can roll back at any time. But, as John pointed out earlier, you must have Antivirus on it.

That's what I thought. That's perfect. So I should figure out how much RAM, hd, etc. I need for "one" OS (and one AC) and double it for the computer that I need virtualization on?

Serene

I have 2 computers running AC on both the host and a guest operating systems. Both are 3 year old Dells with Intel Core 2 Duo CPUs and 4 GB RAM and 160 GB HDs. I have one with Windows 7 Pro and one with Windows XP Pro as the host OS. Both of my guest OSs are Win XP Pro, since I could use the Win XP verifications codes from old computers, and Win XP needs less RAM to run fast. I gave each OS 2 GB RAM and the guest OS has 60GB HD space.

To sum up, these machines are very easy to use and switching between the host and guest takes a mouse click. There is a very slight performance lag when running the virtual machine.

So John has made it official; there is a way to set up a virtual system entirely for free as outlined in your linked post above. Any disadvantages to Virtual Box?

And John, why do you find it advantageous to run two versions of AC at one time? I have never really seen a compelling reason to do that (barring the unusual situation that prompted this thread).

No regrets except a slight performance hit on the guest machine (more RAM helps). Oh, and I felt sad when Microsoft's market cap dropped a bit in the last quarter, because there weren't as many computers sold.


I can have my MA be logged into her account on the host and mine on the guest VM, so that she can eRx and print prescriptions. Just like the old days "Susan, call in this prescription for Mr. Smith".

We just set up our MAs to be able to ePrescribe. Although I guess license-wise that is more ethical.

Bert, when you set up your MAs to eRX, they lose the ability to import into a chart and have you sign off on what they import. How do you overcome that?

Drives me crazy. My MA imports every fax which is then sent to me to sign off. That's perfect as I see every radiology report, every pathology report, every consult request. But with that, she can't eRX because her "priviliges" are set too low. If I set them up to the level of eRX, I lose the ability for her to send me imported items.

We've tried two different user names but, honestly, this just sucks in the middle of clinic as she has not log in and log out to switch between importing or eRX, may not know which one she is signed in to, takes time, and is just annoying.

I'm praying that v6 will give a little more versatility in user settings especially with eRX

Which is why I have a host & a guest instance of AC running on my MA's computer simultaneously by using virtualization. Makes switching between the options as fast as a mouse-click.

Ah, so it is not so much allowing one person to log into two charts at once...it is letting one person have two "identities" to log in with different levels of access privileges. That makes sense and could be useful to us as well.

I also think you could open two charts at once, using the same user logged into AC on two separate computers or VMs. I try to discourage anything except eRx or printing Rxs on the VM that my MA uses, to avoid both of us opening the same chart and saving different versions.

Sorry. I overcome that, because I don't import anything.

Wow. OK. That won't work for me then. I guess a VM is doable and reasonable. Silly but doable. Seems like I should get to authorize who can use my eRx account a little more liberally.

I would wait until version 6.07. It allows you to make your MA eligible to ePrescribe under your name.