Home Forums Discussions General Discussion HP horror story

I started AC the first week of November 2011--and much thanks to the user board posts for all the great advice. However unanticipated hardware issues have made the transition much more difficult than it otherwise would have been. The intention of this message is not to berate HP but forewarn new users of unanticipated problems. I decided to go with an elite book 8460 with 8 ram of memory--to utilize in the room during the exam and carry between my 2 exam rooms. It is small enough to lug around and the 14 inch screen is big enough to be quite functional. The first few weeks went fairly smoothly but then started having issues where the AC would close out suddenly then eventually to the screen freeze after booting up, which was diagnosed as a mother board issue. Unfortunately the elite book was purchased more than 21 days before the mother board failure developed, and thus a full refund was not availabe. HP had it shipped and about 4-5 working days later the elitebook was "fixed". Unfortunately trying to continue to data gather\input with just my PC in office as SQL server and my nurses computer, made this time quite stressful. Unfortunately 3 days later the screen freeze developed again. Again shipped to HP, but problem was not reproducible by the tech in Houston after about 10 working days--the box was shipped back but no computer!! The computer went missing so now fed ex and HP are doing the blame game--but thankfully HP shipped me out an identical elitebook 8460 which is working great. Several points learned though. Make sure you get the extended warranty package where HP will fly some one out in 24 hours to work on your computer if you live in Montana where the certified HP techs are few and far between. The other point learned is that I have a better grasp on how the exam room laptop complements the office PC--the laptop best used to print up "up to date" handouts and eprescribe at the encounter and the PC to finish up my note doing the finishing touches with dragon. The laptop used mainly to get the work done at the encounter and the PC to tidy up the documentation. In the early stages I was trying to dicatate and do everything with the laptop in the exam room--which with being without for a period of time taught me how to be more efficient with the lap top.
My 2 local IT guys have worked with HP's for years and have never heard such a scenario play out before. I have 6 other partners just starting AC and after seeing my struggles are a bit leary to go with HP. That being said, call me naive or crazy but I think I will still go with HP in the future. I will just get the appropriate extended warranty.
I just want to say though with the implementation of AC and now utilizing updox, that the challenges and new problem solving required to go paperless has actually added a whole new slant to patient care. Its been a great time to clean up and organize up to 18 years of records, but more importantly has made practicing more gratifying. Quite frankly the main impetus to get started was the 18K meaningless use check, but at this point (i hope to get it--don't get me wrong) the efficiency of running the office has really quite suprised me, so if for whatever reason I never get the check I'll still hopefully be able to survive the future.
Once again thanks to all on the user board for all your help and insights--jimmie

I'm sorry to hear the difficult time you are having with HP. I have an HP laptop in a thousand pieces right now, trying to fix it. This is another reason I go with desktops. Replacement parts are easy to find and are extremely affordable. Ten times easier to repair than a laptop. Hopefully when you get your MU money, you might want to consider getting desktops in the exam rooms.

hardwire desktops in exam rooms to a fast router - whether you use a server or large desktop as your hub shouldnt matter...but keep it simple.....hammers make good holes for cat5 cable..just imagine its the head of an MU inspector when you swing....

I have laptops in each exam room but they are hardwired. I had lots of troubles before the hardwiring. No problems now...knock wood. When the power goes out, I can finish my note and shut down.

I have been very happy with the Fujitsu Lifebook series. I have used them in three different offices now. I also run a Dell Vostro laptop and it works fine. All of these are wireless.

OK, as everyone know, I have to get in my opinion. You are either pro P2P or Client/Server (analogy) or pro desktop or laptop.

I agree with Sandeep. In my "opinion" the only way to go is a desktop. You aren't moving them around, parts are cheaper, easier to fix, etc. Buy a desktop and throw in an SSD SATA III and you will never go back.

For me the carrying them from room to room is just not efficient.

As to HP, they used to make a great computer, but now I only use their printers. If their PCs were as good as their printers, they would own Microsoft. I started with an HP server and it broke all the time. Luckily, I did have 24/5, and they came out and fixed it. Took awhile though. Dell would have come out and taken me to dinner while they fixed it.

I like Lenovo and Lenovo Thinkpads. Sony makes a good laptop. But, what is wrong with a hard wired Gb desktop? I would highly recommend not getting HP. You can say what you want about Dell, but they tend to get the computer in the box.

Wow Bert, you took the words out of my mouth haha.

Desktops are cheaper and have better performance. You could probably buy 2 good desktops for the price of one good laptop. If you want really small desktops, look at mini-ITX computer/slim towers, though I personally prefer mini tower and above. You need nothing more than a screw driver or less to replace a bad part. Laptops require significantly more technological finesse.

I like Lenovo think pads as well. Just got my x220 a few months ago. Desktops, I usually go self built. But dell tends to make some nice ones and they often have good deals on their vostros.

HP's enterprise line is really good. That's probably why your IT guys like them. HP even considered closing the consumer lines of their products.

Jimmie,
Thanks for sharing that. The above posts focus on the hardware aspect of your post. In addition, I was struck by your closing:
That matches my own experience and I think is an important take-home for those considering an EMR, especially AC.

thanks for all your great responses-
Now that I am no longer doing any hospital work it's nice to be in a "cloud based doctor's lounge" jimmie

Laptop repair successful! Like you, this person also had a bad motherboard. (Wouldn't stay on long/many random reboots). It's definitely a laborious task to replace it. The root of the problem starts with untrained individuals assembling these computers. A lot of them overheat due to excessive thermal paste being applied to their CPUs and GPUs on the motherboard. As a result, they tend to overheat. Even Apple's/Mac's own service manual recommends applying so much thermal paste that it acts as an insulator and results in greater heat. THIS is actually how much you need for optimum cooling. So I guess it's more whoever wrote the technician's manual, but I digress. Previously the temperature was at 80C/176F, now it's at 35C/95F now. Running these components at high temperatures reduces the lifetime of the device.


Images of the repair below:
EDIT: DO NOT TRY THIS AT HOME.

Sandeep, I am impressed with the above pictures. Is that a cordless soldering iron?

On another note: I no longer trust HP. I had loved HP equipment from my first HP-67 calculator in college, and even before in high school when they sold some of the first LEDs from the back pages of Scientific American.

I had TWO hard drives begin to fail in a RAID 5 array in my HP server, and their tech support was so incompetent that I ended up actually suffering needless data loss. Only one impotent regional manager has apologized without compensation and with heavy sales pressure for worthless service contracts that even he acknowledges would not have prevented my server problems. I have increased my backup plans and hope to replace the server when I can afford.

Take home message:
DO NOT BUY HP!

Agree totally with mkweiss about HP: I have had a dead laptop, a dead desktop and a dead NAS from HP in the past 6 or seven years. All the Apples and Dells bought in the same period still in service.

I use permanently stationed laptops in my exam rooms, for many reasons I like them but won't get into all the reasons why right now.

I would like to followup on Sandeep's comment about overheating. My laptops sit permanently on high flow cooling pads, thus keeping their temps at reasonable levels. This should be part of any laptops setup, esp if the computer is on all the time.

Cool pads are good, but you can't beat an old fashioned desktop. I like having a separate mouse with extremely high DPI settings (5700). Laptop mice/regular mice seem sluggish. I mean if space is an issue. You can get mini-ITX cases ( http://www.newegg.com/Product/Product.aspx?Item=N82E16811129080 )with intel brand motherboards ( http://www.newegg.com/Product/Product.aspx?Item=N82E16813121513 ). This wouldn't be much larger than a ream of paper. (About twice as thick though). This a Q67 motherboard too which allows you to use KVM remote control along with other intel vPro features. This would be top of the line. Desktop power >> laptop power (@ the same price).

Point well taken Sandeep and I agree in concept, but it's a personal preference given that I use a mobile kitchen butcher block stand on wheels. I like the small footprint of the stand which turns easily to face the patient whether they are on the chair or up on the exam table. Plus I like the mouse pad b/c it's relatively quiet and doesn't "click" every time I want to double click open a file. I do a tremendous amount of multitasking when pt's are talking to me, and I don't want them distracted by the fact that I'm doing work while they talk with audible clicking.

My 2 laptops are turned on 24/7/365. With cooling pads running 100% of the time, they have never overheated. In fact my old laptops were on nearly continually for 4.5 years before I retired them for new ones. I brought the old ones home to use, and these have become my home PC's. I use Sony Vaio's which have sustained my 1 liter water cup being spilled all over one, and a single drop from 3 feet off the butcher block by the other caused by a medical student.

we have 10 clients in my office, 8 are desktops. But for my setup in the exam rooms, the laptops affixed to the butcher block stands and hard-wired to the network are perfect.

Being Jimmie's partner I KNOW that he is at least a little naive, crazy or both, especially when it comes to HP laptops. Otherwise, he is a great guy and has helped me a lot. I have have recently started AC. I took the route of having all in one desktop workstations from M-Tech Laptops installed in my office. These are desktops. The quality and service from M-Tech is subperb but it costs more. I used Lenovo laptops in my exam rooms for years to access the hospital data base, Internet, etc and always had problems with my wireless connection. Now, everything is hardwired, I am using the all in ones in the exam rooms and it works great. The patients are impressed because they can see the data entered on the screen and readily participate because they can see what the nurse or I am entering. Like Jimmie, I will then finish the note with Dragon in my office. I have just brought a M-Tech server on line now, having used an M-Tech laptop temporarily for the server.

I have used HP, Dell and Lenovo computers for over 15 years and have had problems with all of them. I strongly recommend that if a user wants to purchase a reliable computer that they at least go the the M-Techlaptops site at www.mtechlaptops.com and see what they offer. You can also talk to a real person in Michigan, not half way around the world. They are not paid on commission and have great pride in their products. I have one of the 8700 laptops and had it designed to work optimally with Dragon Naturally Speaking. They will work with you to find the optimum equipment for your individual needs.

I was happy with HP machines for awhile, and then they were terrible.
Gateway...same story.
I used Dell and they were good, then they were bad, then they were better again.
Toshiba...same story.

The somewhat surprising take-home for me is that no PC maker has been able to consistently create a good product with decent service, and maintain that for a significant period of time. Each time you shop, it is almost like looking for the first time. The only exception may be Apple, which doesn't do us much good with AC. Maybe there is a message there.

A new trend is that most people are making their own desktops. It takes less than an hour and you pick each part to your liking. There are sites that build it for you too using parts that you want (iBuypower/Sager/Cyberpowerpc). Pick the highest quality parts and it'll run well. It's a lot easier than you think and if there's an issue you can replace/troubleshoot instantly. Dell, HP, etc. use the cheapest parts they can find. Most of the power supplies aren't branded and are low quality. Motherboards tend to be proprietary as do their cases. That means if something goes wrong, you can only buy their brand replacement part.

I was going to say the same thing. My guess is if you tell Sandeep what you want, he will send you a list directly from NewEgg complete with directions on the install. The only somewhat difficult steps are installing the mobo correctly and being careful with the processor. Need to use just the right of thermal paste.

Sandeep, why don't you suggest a list (with PDF of NewEgg parts) for a middle of the road i5 computer. If someone wants faster, you can suggest your Crucial SSD, while I will go with OCZ or Intel. And, if they want less they can ask for less.

The M-Tech concept is to get the highest quality parts from the manufactures and put them through additional testing before they ship them out. They caught a defect in the mother board of my server, where it was rarely randomly rebooting, before it was shipped, by stress-testing it. They then replaced the mother board. They told me that the big manufacturers would have already shipped it out because of their lax quality control.

For those physicians who do not have time to build their own, I again recommend M-Tech. See the link above. In looking at things computer, it seems that we all want to get by without paying a lot of money for equipment and such. There always seems to be a lot of great bargains out there. However, this is because they use inferior parts with lack of quality control, accepting the fact that there is going to be a certain failure rate. Look at Jimmie's HP computer. We would certainly not tolerate this in our practice of medicine as we always want to give our patients the best in regards to medical care, medications, et cetera. I am very thankful that, with Amazing Charts, we have gotten much more value than what we paid. This is truly an exception to the norm

It is not just HP. We had similar problems with 2 new Dell laptops. Our solution is to always have one spare laptop, configured and ready to go with Dragon user profiles for all 4 providers. Then when it turns into a shouting match between our IT guy and the manufacturer we can keep seeing patients.

Bert's right. The hardest part is installing the CPU. I'll price a few builds for various ranges/setups. Everything else 1) insert part in slot, 2) plug in cables.

Why not desktops in all the rooms?
1. Lack of space.
2. I am old fashioned, and I just can't bring myself to sit and look at a patient over the top of a screen, and sit there typing. I look at people when I talk to them, sometimes I sit next to them, and I move around the exam room. Sometimes I actually get up and TOUCH a patient! Physical examination is highly underrated in this era of electronic imaging.

I have been working with AC for almost a year, and have settled on Motion Computing tablets -- I have an LE1700 and a CL900, both of which I got off Ebay, and both of which seem pretty stable, though they have their issues. I also use a Lenovo 200X tablet, also from Ebay which I have been using at home or on the road to finish my clinic notes. I use Dragon and keyboard together for touch up and complex notes. (Standard Dragon works pretty well in Remote Desktop, sometime I'd like to try the official medical version.)

We use wireless in the exam rooms, and have very few problems -- when things are slow, it is because someone else in the office is scanning documents into the AC database.

After some practice, it is possible to use the handwriting recognition in the Win7 tablets in the exam room, and it is mostly just like the old days of taking notes while interviewing patients, then I put the tablet down, examine them, then make some more notes. Patients don't mind the electronic intrusion, and some think it's cool.

I finish the more complex notes at a desktop or laptop, where ever I am -- with Remote Desktop, I'm not limited by location, and I no longer have to lug boxes of charts around.

Added advantage, if it is a simple note, or the right-click boilerplate happens to suffice, you can just sign it off at the end of the visit.

You can also call up and print patient handouts, and do immediate research for patients who have complex issues -- they really appreciate that, and since I am face-to-face with them, I bill for the research time as "counseling." Otherwise, its on my dime.

Everyone is limited by their own setups. We have tables and have set them up so I can see the patient. So, we have no problems with desktops.

I usually sit sideways to the parent or patient when I am charting. I have learned to type and look at the parent and hold a conversation whilst my fingers are moving. That's the result of a lot of practice.

Usually, I spend the first half of the visit talking/listening/examining so that when I sit at the computer, I have it fairly well thought out what I need to type. HPI is the main area. Others are mostly modified templates (I actually have to concentrate more, but they are quicker.) Sometimes a template will bring up a point I did not querry. Rarely I leave the room without a complete note.

These are all desktops, hardwired. Actually, I went in the opposite direction. Most of my computers were self built, but I found that often 1 generation back "refurbs" (funtioining off lease) were less expensive and fit the build. Servers were built by me.

I really like the pictures Sandeep--I was trying to find an abacus and slide rule to put in a box and take a picture to show you my stand in laptop while my HP was on the blink, but you will have to use your imagination.

I'm keeping my fingers crossed but so far the "new" elitebook HP 8460 is working, and not hardwired and no major issues yet--but when the time comes to replace I will take everyones' perspective into consideration. My partner Mel has about the slickest set up I've seen, but I have to wait for the meaningless use check before I do any more purchasing--jimmie

I just finished my PC Hardware Recommendation thread: http://amazingcharts.com/ub/ubbthreads.php/topics/40389/PC_Hardware_Recommendations#Post40389

You should try desktops next time.