Home Forums Discussions Problems DEEP THOUGHHTS by Walter Handy

Bert is extreme. Such a waste talent in pediatrics. IT or Wall Street paying more plus year end bonus plus more excitements and heart racing moments comparable to trauma level 4 care. The major disadvantage is that Bert can not practice till in his 80s. I changed my mind, stick to medicine, even boring it is safer bet.

I am sorry to use the word redundancy not in an absolute term. My redundancy should mean cloning with differential upgrades. Even they are cloned, to be true redundancy needs to be real time. For local redundancy there is RAID or external hard drive software.

There many true sync program out there like sure sync, vice versa (60 bucks).. to copy any file changes to a clone computer. We are doing sync twice or more a day, during lunch time and after hours between computer 1 and 2 and once a day with computer 3. For the last 4 years I am using free Microsoft Synctoy to sync between AC backup and imported items folders. Imported folder is about 9 gig and sync time on our quad Xenon is about couple minutes at 50% CPU. For the remote computer 3, I use log me in to copy latest backup file and copy with overwritten option for imported items. Those sync tasks are much simple then texting, so any trusting person in the office can do it. I don't know if Server software have this sync function built in or not as I don't have experience with newer server software, so any question about Server OS needs to direct to Bert, Indy, James IT or Sandeep. My learning ability is diminishing to a point...

As I keep AC running in all three of them, I can do a quick test right away to see if they are working. even switching computer 1, 2. Doesn't matter what happened, my doc can keep on working, I can fix most of problem in minutes. Switching in computer 2 if 1 crash and do the fixing later. PC 2 is half a day behind PC 1. I don't even bother with automatic sync because then I'd be out of my three meals a day job.

I don't know but seems when you have too many back up computers running, rarely any problems almost like a warranty, but as soon as the warranty expired....

Time is changing. Unless you build pc for fun or most powerful, I think for most it is more economical to buy. Last year I read another article about individual pc builders, a dying breed. Currently it costs more to build, especially if you have to buy OS, and the your middle range built might not be as good compared to OEMs.

I've been building pcs for some time, till last year. By the way I am teaching computer science but no longer like it as much. Technological advances make people living in a virtual society. Latest research saying that when people texting they lying much more. We have more distraction, blue tooth earpieces stucking into ears to block any bug from escape and radiate our brain with electromagnetic waves. Shooting in games is so much fun also desensitizing body values...

Upgrading custom built pc is promising idea but not realistic. Many of my custom built pcs became obsolete within 2 or 3 years. Like memory upgrade, ddr to ddr2 and now ddr3, ddr3 is getting much cheaper then ddr 2. All my custom built pcs using ddr2, 2-4 years old. Ethernet is now gigabits, I had to do the upgrade late last year by buying gigabit Ethernet cards for all. I7, I5, I3 replace core 2, P4..... Socket boards...

One thing I hate the most, I am an audiophile, is power supply noise. Most of custom built pcs are much noisier than OEM pcs. There reasons for that. They need to use lower wattage power supplies, cheaper and meet energy guidelines of Fed and corporate energy policy. OEM pcs not built for upgrade so power supply just enough. Except for higher end models, lower to middle range OEM pcs have very little noise.

Again my one and 1/2 cents is looking at reputable brands and compare prices when they are on sale. 300 bucks can buy you a good enough for office use including AC client with latest Win 7 HP. I just bought two Win 7 Pro licenses that cost 150 buck each. How you can built a pc now aday for 150?

AC team might want to work on an android version or Apple version and be ready for Kindle Large or Ipad 4

Reward money well spent!

We got the reward money and all employees were given 2 week pay bonus.
Love and health can not be given but money is something we all much care about and able to share. Average values are best. Too much money causes trouble. We are striving for 10 year goal of becoming millionaire to comfortably retired, I am not sure I am be around then, but at the time being small things can bring about happiness .

We registered since June but my doc was so busy she did not time to complete all requirements till Dec. Our upgrade to Win 7 64 bits also caused a 2 mos delay because Quest results could not be imported directly to Win 7 64 bit. They were able to figure out how to do it finally. Lab results imported in HL7 then converted to pdf. We had it done last year but the way HL7 format, multi pages of text files, cumbersome to read then we decided to stop the direct import but scanned in those results in pdf format.

Now everything seems running smooth. AC 6.1.2 is amazingly stable under Win 7 64 bits, only thing I have to do is restart the main pc once a while just to see if it is alive.
Another tips to for anyone want to get tablets for AC. When we started, I bought Fujitsu tablets, 2000+, so dependable, keep on running after 4 years, now given to any intern, but then last year I decided to follow some financial tips to buy used equipments instead of new and bought 3 Lenovo (IBM) X60,61 tablets on eBay. only 200 each. I upgraded one of them to Win 7 to see if any improvement, no OS on those used tablets. I have extra licenses for XP. Not much difference in performance between those tablets running XP and Win 7. By the way older tablets have 14 inch normal screen, much better than newer wide screen, more compact and larger real estate.

I have to say AC team well deserved a raise. For mos now, our AC runs like those Maytag appliances. Given reward money, i have to say great job AC! Wow money does have its impact.

I could tell two kind of users in the forum. Many just like to read one a while and ignore tech talk, over their heads and I am one of them. Many like to help and their expertise quite amazed me and the forum would get so bored without them.

In my class I kept telling that I am more a practical person than an academic or a thinker. On some larger IT projects, million dollars mean nothing. At one time, the complexity of keeping 5 thousand plus data table, in mainframes or mid size computers, in sync became too much too handle, higher level management decided to drop the project. Other time, the cost of linking too many systems from company merging got out of hand and again higher bosses decided to drop, small changes. Docs and admin/IT staff almost have no say in real world but overburdened by alien force. I copied the word form our tech talk post.

I could not recall that I am telling in my post before, I don't like the word blog Bert gave it to my post that much, might be 'junk talks' a better name, since I am not a writer and not good at it, skipped most of my literature classes, felt asleep in Shakespeare, but was able to stay overnight to punch computer cards, remember those, about my IT friend who telling me about his saving of million dollars, in high end IT, we were making as much money as docs! On that one project, he collapsed on a side walk on his way back from client site to the hotel and died of heart attack. Young guy still in his early 50, common news now a day those.

I also mentioned about my doc out of her frustration saying that she is like a dumpster. One patient came last week, looking very healthy telling that she just need a yearly PE. Then a couple day later went back for a second visit show her health ID with my doc name as her pcp and asked for her disability form to fill in because of leg pain..... Docs in the forum know about those forms now a day, such a pain in..... primary care docs ranked bottom of the income list, even their income much higher than average, in my opinion it is not worth it to waste your life away to be a primary doc if you don't try to balance your life, AC addiction included. Haha AC is best for solo docs, easy to use, amazingly stable, don't blame AC if your e prescribe is slow sometimes, internet is not that ready for second generation yet. I did make joke about big boss Jon but his love for AC unquestionable.

Another trick for anyone doesn't want to invest big bugs on hardware and keep things simple. Dell selling refurbished super compact desktops, Core 2 3GHz, high end 3, 4 years ago with Vista Business for 100.00 on ebay. I think some of docs out there can buy 4 of them for 500.00 and you set for another 3 years. Win 7 based on Vista coding framework, and later Vista with update is almost same as Win 7. I bought twos and loved it. Ready to run with nothing on except OS, download AC and some free antivirus and you ready to go. I am a different person now, something simple and works is perfectly ok for me. Older piece hardware been time tested, I still had couple of them, refused to die after more than 10 years. Sound familiar, am I an older hardware piece too? no wonder the attachment.

Sorry Walter. You just tell me what you want to call it, and I will take care of it.

Walter's Words of Wisdom?

Gene

Your doctor is not alone. My most recent was a guy who demanded a letter saying he could not work because of a month old work related back injury. The previous weekend, a mutual friend had come across him doing a 90 mile snowmachine trip over rough terrain.

My all time best was a guy who came in with a CDL truckers physical form, and Social Security disability papers, both to be filled out at the same visit.

Gene

Gene, I still don't understand why you wouldn't fill out both papers for me.

Walter,
I am struggling with getting a server Vs. keeping things simple-- getting a PC with a mirrored drive and having NAS as additional back up, but I like your concept of frugality and functionality. Thank you for the recommendations. I'll have to chew it over some more.

Jon, he didn't say he didn't.

Gene, was it "Oh, doc, one more thing." He could have at least made a follow-up visit.

Hi Bert,

As a pediatrician, the irony of this may have been lost on you.

To fill out CDL, I had to say that he was in perfect health.

To fill out disability, I had to say that he was totally unable to work.....

Gene

No, it got it.

In pediatrics, it's more like "Can you call in Tylenol and fax the form to the electric company?" As they drive off in their Jaguar.

Jimmie,

I am overwhelmed by current software complexity. Old XPs still running in our clinic, weird problems happened sometimes. Only Microsoft programmers would be able to tell its OS internal structure and at lost when come to third party/virus software interaction. When you call Microsoft, probably simplest and last resource fix is starting from scratch and rebuild...even security experts telling virus protection software is in defensive mode and behind their enemy. Best protection same as our body mechanism, docs know best, to attack full force first before virus getting in mass into inner cells

Many forum members with deep tech knowledge, available budget, IT support or planing multiple offices with many partners, a real server OS/hardware would be 100% better, and give them high satisfaction because of their new toys' security, scalability, enterprise level of dependability, almost same feeling like driving top of line Mercedes, BMW, Lexus... David would tell your Bimmer is useless in Alaska, need to know how to fly, I did not ask if he owns a turbo jet Cessna but not a villa in Spain or not.

Others with less tech know how better to stick with what AC was designed for and its technical staff is able to support. Last year when I called AC tech support about upgrading our OS, they only recommended Windows 7. Simple software/hardware make easy fix and be replaced in a solo environment and help preserve doc time (money).

Bert set up is high end and out of my league. I am more enthusiastic when I am jealous. Sorry Bert, don't ban me, please.

Do it the easy way. Have enough water, foods, gas, hard drive, power supply to last at least 3 days or more because no one would come to your assistance in time. Also a generator, because AC is useless without electricity unless you have perfect memory to remember all your older patient medication lists. They surely would ask for money back. They tried multiple times but failed because my doc is such a perfectionist. 10 step treatment doc? you got it.

My doc is looking for a partner who likes to make much less money, TX cost of living is low. Another patient came in last week telling how my doc can make money the way she treated him, that is why our annual IT budget is now almost down to much less then a single Prolia shot.

I would never ban you Walter.

Ten days ago was Xierdaxinxi (the Singapore egg seller), yesterday Andrechuk. Bert has been banning like crazy. I can see why Walter is nervous. I know I am on thin ice myself....

Walter, I used to agree about the BMR... then about 2 months ago I got hooked on Top Gear. Now I want a Bugatti. I'm afraid it will have to wait however, along with any new turboprops.

@Jon,

That is way too funny. But, I don't tolerate humor here, so be careful. Too much humor is only a seven day ban though.

So an attempt at humor that is not funny gets you what?

Gene

That would be a permanent ban. But, I will have to talk to Roger Goodell first.

OK I know its 5 pages back now and I am a bit new here on the forums, however in regards to the original post...

There is a macro language called AutoHotKey that I have used to create custom screens that can read and write data into and out of the AC app. It does it using the interface (no database access though I was tempted).

It can be as advance or simple as you like. I made one for a pain clinic that walks them through the appointment asking the questions they fill in the answers with drop downs and clicks and it creates the text. Or you can create short abbreviations that will automatically turn into longer text.

Hope it helps.

Kevin

Walter,

You are doing better than my wife --who is a hot shot with computers and making the theoretical to practical happen for me, but --if I pay her more than $599 it costs me more to keep her on the payroll than off, so I may not even get the help in 3 days with those wages.
I hear what you are saying about the lack of electricity, but there are only so many contingencies one can handle on a dwindling stream of income, with the unaffordable care act looming on the horizon.
However, if you want to make even less money come on up to Montana where you can at least pay state income taxes as well.
Seriously, thanks for your feedback!!!

Kevin,

Can you tell me more about your macros? You can PM me if you like.

I second the use of AutoHotKey. It will also click buttons and item in a absolute or relative position in a Window. I use it to "play" data (e.g. PMH, SH, etc. from a DB) into the appropriate section of AC, then click or check all the MU boxes as appropriate (e.g. we do and have done med recon forever, and now always have the box checked).

Walter,

I apologize for skipping over Roger and Bert and Kevin, but your earlier comments really have me interested. My brother in law (IT guy in Tx) and you are, I think, essentially recommending similar set ups, and often time when I have found two relatively unrelated entities saying the same thing often time will get my attention. Your post #44170 where you are talking about not spending big bucks and keeping it simple sounds very similar for recs he is suggesting--Server Vs. desk top---he says buy a good desk top made for business (functioning as your server), with either windows 7 professional or windows 7 ultimate--as both can encrypt the file system and run the remote desktop server. He suggested looking at factory refurbished workstations such as the Dell outlet such as the T3500 with the Intel Xeon X550 or HP z210 models with the i7 processors.--a system with 2 drives to mirror and 8 GB Ram minimum and 1 quad core CPU mimimum. I think if I am reading your post correctly this is very similar recommendations. I, like your wife, have to be frugal, my wife demands it! And I think one can still be frugal and maintain functionality. And as you can see by my logo, I like old hardware as well--1981 air cooled vanagon, 0-60 mph in two weeks.

Again disclaimer, Bert and/or AC not responsible for personal opinion.....

Gene, words of w. sounds terrific but might cause me heart attack and you are too far away to treat, my doc refuses to provide care to her immediate partner... I always felt for someone who much smarter than myself but smart mind always go along with critical thinking ... I was so naive....
Kevin, can you tell more about those hotkey works, I am illiterate about those and not much an AC user. In clinic I just make sure it is running and all client connected.
David, my forum second love after Bert, haha I very much like to put him before Bert but then changed my mind..., probably he been flying around long and high in those remote areas and see things differently....
Jon is somewhat different, he is making more money than most unless he refuses to see more than 5 a day, any hiding radiology and ortho docs in the forum?, but Jon is nice and also going for frugality, he could be our majority leader. I endorsed Jon.

Wow, we are blessed with so many wonderful members, words of wisdom and caring should be labeled to all.
AC is lot more than itself with this forum. I once told my doc if you have any question just tell me to post it... when you are stressed out, post it, then forum collective thoughts would ease your pain, resistance is futile.

Jimmie,
A suprise to see that your IT brother in law thinking same, even down to Dell refurbished desktop suggestions.
I thought I am by myself in that because many would think of it as too cheap and not that very doctoral way to go.
Really you can put down couple of thousand dollars or 10K more and go for Dell or HP or Lenovo small business leasing deals. Small monthly payments and peace of mind knowing that all equipments are new with warranty. Business expenses depreciation write off . ..

When we started we went through that. But then after 4 years, brand new option was no longer that attractive. Our little EKG, over 3000 dollars then, went dead after 3 years, only one year warranty, it cost 1500 just to look at it, so we decided to buy a used one built like a tank for 500 bucks, works fine. Yesterday afternoon, one old patient came in complaining of feeling so tired, my doc listened to his heart then ordered an EKG..a call for ambulance to get him to ER. Since we got this old EKG, not that many functions available but served well, many more times than the previously brand new EKG now dead.
Same thing happened to our defibrillator. Electronics in modern time doesn't last that long, too many plastic part I guessed and they are designed to be thrown away, good business sense to boost economy. We just finished our monthly leasing deal last month for all those buying brand new then. Years back we would have not thought much about these but not any more in my opinion. To hold on to our sanity and independence by cutting expenses... and I don't know how long would it last.

AC staff needs to create a small and easy study to see how AC responses in different set ups to give more accurate recommendations instead of saying like a minimum this and that. Like 1 doc 2 employees 5 pcs, 2 docs 5 employees 2 offices 10 pcs.... no guess work or need to check around and confused by too many recommendations.
I can give you an idea about ours with almost zero problem since AC 3.6 and now 6.012.
Started with Core 2 6600 2.4 Ghz 2 Gig ram, 1 thousand dollars, to be used as server and 5,6 mixed and match low power Pcs and 1 tablet, both wire and wireless... it ran fine then
Two years later, I upgraded our 'server' to a quad 9550, cpu on sale for 200 bucks, put it together myself, 3 wireless and 6 or 7 clients.

Another two years gone by, getting bored with our quad 9550, not much excitement at all, went out and bought this time a used Dell T5400 Xenon Quad Core, 4 gig, reinstalled with Win 7 Pro per AC tech advice, 350 bucks. Business work station/server picky about memory , requires high end ECC Ram, 8 Gig for 200 bucks. Nothing much happened still. I hardly felt any dramatic improvement in performance after living with three 'server' generations except when AC doing its encryption back up with imported files included (about 9 gigs), without imported files only less than 200Meg files.
Our upgrades going along with newer AC versions. Most the time, AC loads were all under 20% AC is just data in data out application, not much more than that. The bottle neck mainly from data queue and/or other concurrent processes with higher priorities, drug interaction in the cloud, the need to wait for data request from one client to be completed before going to the next client. Rarely, assume 8 clients ask for data at same instant, than the wait is longest for last client, first come first serve. AC is still 32 bit application, there some advantages to go with 64 bit OS and lot more RAM but not that much. Mostly user perceptions but no study on performance differences from AC.
Our current main has 10 gigs and it never utilizes more than 4.5 gig. Probably for Win 7 32 bits with 3 gig Ram, a bit slower but no one knows how much. Then we have to kill any unnecessary services to bring the memory consumption down. Live within your means applied. If it doesn't have enough memory then OS will swap data into hard drive.

I like our latest refurbished Dell T5400 because the way it built, heavy steel. So I bought another T5400, newer T7400 can cost you thousand of dollars, one on Ebay selling at 4K plus. Mostly refurbished pc has only single CPU, I bought another CPU to see if I could run it dual CPUs. Windows 7 failed to install with dual CPUs, not a matched pair. CPUs need to be same stepping but then runs fine under Vista business. Microsoft forum did not come up with a solution for mismatch CPUs. However our dual quad core CPUs have a total of 8 cores running. From CPU benchmark, the score of my old hardware is in the same league as many I7s. Theoretically, if AC was written in 64 bits with optimized parallel instructions then my old hardware with 8 cores would outrun Bert older generation I7. For 600 hundred dollars!

So it is not that difficult to choose, buy used and no monthly payments but need to have a tech loving kid (spouse included) around. Buy new, paying monthly or write a big check but be able to sit back and relax and no need for family/friend help.

One or three day system down is not much a problem. Have plan B with paper chart back up.

Hi Walter,

I love reading your blog. I know you don't like blog, but it is. I am glad I am number one.

You have so much knowledge about computers. Irony is I get just as confused, blown away and fatigued reading your post on computers as I do Sandeep's right down to the "ha."

I would be interested in knowing more about your practice, your family, your patients, etc.

Walter,

Thank you for opening up about your practice, and I have to make a disclaimer. My brother in law the IT guy in Texas is my wife's brother, and both grew up in rural Montana growing up on a wheat farm, and their dad is as tight as the bark on a tree (he would not mind me saying that, and in fact find that complimentary), but he passed the very conservative business approach on to his kids.
"You don't buy something unless you have cash". With that being said both are extremely logical, mathematically gifted unlike me who tends to be too subjective and quite illogical, thus my constant difficulty with trying to get this stuff figured out.
But, thank you for all your great advice and laying out such a methodical well thought out approach, and not to take away from Bert or Sandeep or Jon or David or JamesNT, or any of the others, but I wanted to tweak your experience being a professor and ex IBM tech guy and you sure delivered.

Then Walter should be using Lenovo.

Jimmie, you are going to have to put that disclaimer in your signature, lol. No, not really.

I always wanted to be mentioned in Walter's Blog. Admit it...you all do.
Not just a mention, but apparently I have Walter's endorsement for something. I think. Unfortunately that seems to be based on a mis-perception of my financial status.

Jon, apparently you are only seeing five a day.

Bert,
I will have to keep my wife off the computer for awhile.

Bert tried a one time disclaimer as you suggested but took it off and it did not stick so the above post doesn't make a lot of sense

disclaimer read--my wife and brother in law are tight wads

Yeah, before I opened my own practice, the owner (a physician) of the practice I worked at was the tightest person for money I ever knew. Two examples.

We had a template for allergies. The name of the template was NKDA. Clicking on it made: No Known Drug Allergies.

We never new for a few days why he would get so furious that it said, No Known Drug Allergies. He came out of a room one day screaming, "Make it say NKA, No Known Drug Allergies." So, I changed it to NKDA. He screamed again, "Not NKDA, just NKA." When we finally asked him why, he stated, "Because it uses less toner."

I was always running out of paper for my printer so I asked the MAs to add paper everyday or check to see it was full. So, they asked the owner if they should fill his printer with paper everyday. He told them to put in 20 sheets and only 20 sheets. Like you were going to tell the mother that you wanted to write for an antibiotic, but you had used the 20th sheet of paper.

What benchmark? I know people get mad at me for mentioning model numbers. But I do it for good reason. This is a good example here. Just saying that it's a quad core doesn't tell us what generation, year, or clock speed. If performance was based purely on the number of cores in a processor, Intel would be out of business.

For instance, I looked up your T5400 server and found out that it typically uses the Xeon E5405. The E5405 has a clock speed of 2 GHz, also no HyperThreading. If I'm right about the processor, then you "downgraded" from the Q9550 (2.83 GHz, quad core, no Hyperthreading). Even two E5405s will not compare to Bert's i7-2600Ks (Quad Core, Hyperthreading, 3.8 GHz turboboost, SandyBridge Architecture) (those are in his desktops btw).


That feel you're looking for will not come upgrading your RAM or CPU. You're looking for the SSD feel. That will give you that snappy and swift response that you've been after.


AC maybe a 32 bit application, but SQL Server is not. Unfortunately, the SQL Server 2005 Express bundled with AC is. You said it yourself. AC is essentially data in and data out. AC is just an interface between the user and SQL Server. I can see AC's reluctance to upgrade to the new one since the main improvement between 2012 Express and 2005 Express is the database size allowed is 10GB (instead of 4GB). The RAM limitation is still 1GB. Even after 7-8 years with AC, most people's databases don't exceed 200MB. (Imported items are not part of the database).

Buying new vs buying used has its downsides.
1. No warranties. Most likely the warranty has expired on every part in there. There's no guarantee that the used parts will work very long/at all. Buying a used hard drive is a pretty bad idea for many reasons. Average failure rate only increases as time passes. If more than 3 years, I don't think it's worth it.
2. Tech Support Costs. You will need to do your own tech support or pay someone else to do it. There's no Dell tech support which will remote in and check things out or come down to your office if there is a problem. You will have to foot all hardware replacement and IT costs.
3. Legacy pricing. I'm sure many have noticed that when you were upgrading older computers with more RAM (DDR or DDR2) that it's almost double/triple the price of DDR3 for the same capacity. Those older processors are also more expensive (and slower) if you want to upgrade.
4. Limited and expensive upgrade options.

All of these things tend to cancel out the price savings of used hardware. If you can find used but relatively new stuff, you're in good shape I guess.

Check your local high school/college. There's plenty of kids with exceptional talent nowadays. You'd be surprised. Most of them can wire your entire office with CAT6 and set up your entire network. The really good ones can administer a server. Forms of payment include but are not limited to cash, check, or pizza.

One thing I like, and you only get to do it at one time, then maybe carry on. I am lucky enough to have the exact same computers with the exact same specs. FYI: I am not saying you need this to run AC.

Just makes it easier to upgrade or troubleshoot. When one part starts going bad, chances are you have to watch the others OR it could just be a bad part. I definitely like the same OS and bit. Of course, I have all OCZ and am starting another Lenovo with Intel. (Sorry, Sandeep, Crucial next time, just not crucial at the moment).

Sandeep reminds me of some straight A students in my classes. One of them told me about his interview at UCLA, same school Sandeep going to, long time ago, like over 10 years. At one time he told the interviewer about his extra curriculums. his straight A record... The lady replied most accepted students are same....They are all smart, gifted and what makes you think you are better than them. We are lucky to have Sandeep in the forum to solve our technical problems. I don't want to sidetrack but also the world is better or much worse depends upon younger generations. Without them no older, evil alien force can do much.

Sorry Sandeep most my posts are just small talks, how we operate, or making jokes, not really technical. Your points are well accepted.
I did download the CPU benchmark app from web, don't remember the exact name, but kind of popular, top on Google list. After running, the app uploaded my T5400 results and returned the scores. Our T5400 has dual quad Xenon 5460 3Ghz, with single CPU the score was about 5000+, after added the second CPU score went up to 8000 something. Older generation I7 scores in same range but the latest I7, the CPU score is around 15000 I think. But all those results are just for entertainment references from a popular commercial site. Sandeep is gifted and well trained in the academic world to know controlled tests, reliable references required. Couple ways to transfer knowledges, give one idea and make them think or give many ideas and make them pick out wrongs.

Our clinical operation crisis . Four full time employees but three leaving next month. We are treated our employees well so why.... I'll tell you more...

Walter, thank for your quick and analytical answers to my questions, and also thanks to Sandeep and Bert for well thought out/analytical responses. I agree with Walter, we are lucky to have Sandeep and Bert as well as others.
Chewing over all the data thrown out in a short time will take time to digest, but I think to distill it all down, is what can one get for the most bang for his buck to best fit his needs.
I have learned in my 18 years of practice that one can be so tight that it can damage patient care or flow--I started handwriting notes thinking I could save the 1500 dollars a month on transcription fee, and when I started using Dragon back in 2003, I realized what a poor decision that was.
Now in 2011-2012, mainly out of fear of the unknown (computer stuff), and thinking software would cost 50 grand, I finally relented and started AC, and now realize that I should have done this transition years ago, but hindsight is 20/20.
So I do thank you all for your input and advice, as I have learned that if your willing to listen to those around, often times you can avoid mistakes that have already been made and corrected.