Home Forums What is your dream network for the small medical practice

I'm so computer "unsavy" but was able to move my established Internal medicine practice from group to solo practice in July 2012, buy AC's, hire local IT to buy computers and set up my office network, phones and copiers, transfer several thousand patients worth of data, install Updox, hire and train staff, attest and pass meaningless use by December(payment due any day now), set up outside billing and get through all the trials, tribulations and headaches (which were more then a few)and now have near perfect perfomance of the office without a glitch (fingers are crossed and don't need a jinx now) in nearly 4 months. I guess the point is...if I can do it, nearly anyone can.

Congratulations, I might argue you are no longer so "unsavvy."

@Wendall

Yes I love to tinker, but trying to run a near-solo practice seems to surprisingly take most of my time, especially the endless practice management and after-hours charting. So my Windows 2012 virtualization project (here) is waiting for a few hours of free time - I have the software and hardware ready to go.

I am trying to change my old ways. I like to finish the chart at leisure to give thinking time to my coding as well as planning, looking up references, etc. I would like very much to finish the chart while I am with the patient. However, as my mind frays shortly into the work day, I cannot seem to concentrate enough to make a complete and cogent note while sitting with the patient and listening, diagnosing, prescribing, and answering my wife's text messages.

Addendum,
meaningless use payment arrived.

Jack,
Hope you find that happy medium. My motto as a "non tinkerer" has always been to do what I do best and most proficient which is practice medicine and let others do what they do best, such as the IT portion... which lets me do what I do best. It's overall a good trade and has allowed me to take care of what I know and not get bogged down. Oh, wives interference with non urgent matters and texts would be very inefficient for your work day!

Dave,

I can't believe I read that. I do all of my IT with the help of over 2,000 (free) emails from a Microsoft ITP. He is always bewildered at the fact that doctors do their own networking including me. He is always saying:

Always do what you do best, and leave the other to the rest.

Thank you for your words, Dave. The things is, I need stress relief. However frustrating some IT projects are, they take me away into my younger carefree days of electronics, engineering, and programming. Similar to Bert, I do all my own IT for my practice. To the degree that I know my own stuff, it decreases downtime and tightens the loop considerably between conception, implementation, and tech support.

I have a strange ambiguous setup. (correct me if that is the wrong).

If I had the perfect situation for IT (big-time IT for reinstallation or settring up Hyper-Vs correctly or bailing me out if something catastrophic happen), then sure. But, here is the deal:

1. I don't sweep, my staff does. Two nights a week a cleaning crew comes in.
2. I don't order from Staples, or do the immunization records as my MA does.
3. I don't do the billing. (I have read on here that some do)

4. But, I do do ALL computer stuff and IT.

Here is the bizarre thing. I would have burned out long ago if it weren't for computers. If I didn't have a programmer who wrote F.A.P, VIPER and Amazing Labels. I have had so much enjoyment from TSP800 II printer even though the drivers were made on Pluto. Installing Exchange and SharePoint and connecting my Android phone to perfection with Exchange. And, the best of all, setting up RPC/HTTP so my email from home connects to Exchange, therefore having exactly the same email and eliminating the need for a business and home email address. I love finding certain people to network with such as Rob for Microsoft Certified ITP ummm times 35 years, Raja for ALL things SQL and Gary and Sandeep for all things computers. Working closely with Star Micronis with their TSP800II with driver issues with AC and receiving a free printer. And, finally, purchasing and implementing Currentware to allow my staff to use MaineCare.com but not Facebook. They have offered special deals with my heading it up, but I don't think we can come up with ten trial users.

I remember when my computer went down, and I waited until the weekend to install a new motherboard, I went three days without it. I left each day at 6:00 pm. That would help with burnout to.

Finally, for the first person to utilize www.experts-exchange.com's 30-day trial and solve a somewhat difficult computer issue, a bottle of wine from me shipped to your day.

I have pushed this website for over ten years and not one person takes advantage of it. Sure, work on it here or with your "IT Guy" or on the Internet, but during that let the hundreds and hundreds and hundreds with vast knowledge in the three areas that you require help in and see answers within twenty minutes.

The cool thing about EE is they take on the issue with you working toward the goal of fixing it, not just throwing out a single idea. As an idea, I have over 525 questions with at least 425 answered.

Exactly. I let staff do other things but I keep the tech for the fun of it (guess that's why we are on tech forum). Except we do do billing ourselves (not me, my staff). Among other things, my wife and I used to run the billing department for the medical group as part of our duties, so I get frustrated with other billing services. Our AR days are 20 days less than the medical group and 15 days less than the closest billing service.

I have used www.experts-exchange.com many times for problems, each time finding that my problem has been analyzed and answered before. As the Google link leads to the answers, I never had to psot a question and thus never did subscribe. A great resource. For detailed information on new configurations, I like Microsoft Technet. I especially love their step by step how-to's. Like everyone else, I Google for the rest.

I'll take your advice and look into it. What's the fee arrangement once the 30 day trial is over?

@GoBruins

Afterwards, it is $12.95 per month. It is free if you, yourself, answer 50,000 points per month. Believe it or not, in seven years, I have answered maybe one question. It's like competing with Sandeep, lol.

I use TechNet as well. There used to be a SBSNation or something like that. Susan Bradley used to hang out on there a lot. If you don't know Susan Bradley and you use SBS, it's like the Chicago Bulls being your favorite team, but not knowing Michael Jordan. She IS Small Business Server. Even Bill Gates asked her questions. Just Google her.

Anyway, I digress. First, the offer still stands. And, you can't ask Who makes Lenovo, lol. I understand Jack, but here's a few benefits to EE.

Yes, if I do a search on there, I will get similar questions, sometimes get the exact answer. Have to admit, I am usually lazy and just ask my own answer. I find being involved in the question and asking other questions after gives me a better answer. I also seem to have very crazy issues. Once, I was using a Cisco PIX 501. As you may or may not know, Cisco is consider the best in firewall/routers, but they can be a bit difficult. Out of nowhere, we started having four random computers out "x" many computers not accessing the Internet. If you rebooted the router, you would get other random computers but more than likely the same three or four. I threw up the question, and to this day, it is my longest question both in number of posts and number of days. There were nights where everyone would say, going home to get a beer, let's get some rest and tackle this tomorrow. Rob was trying to help as he is, as I have said many times, a super networker. This is where I met Rob. Rob has sent me 14% of my emails to date after becoming friends. I stayed at the office every night trying to figure it out. Finally, I set up a proxy server on the server and connected the four computers through the proxy. This solved the problem but added more with email routing, etc. But, it did provide a big tip, although even the experts couldn't see it.

Finally, on the eighth day, an expert who hadn't posted at all prior came on and said, "You have a 501 which comes with 10 licenses. If you access the Internet one by one, after ten you can't get through." Bingo. Then, ironically, I went to my Cisco book, which is 10 times harder than Microeconomics, and found the paragraph, "You can only use 10 Internet connections with a 501." Just like Cisco to make you get a 505 or upgrade your license to 50 to run more than 10. So, I ordered a 50-user license and somehow figured out how to upload it into the Pix. Problem solved. Now that question has probably been Googled to. But, I would never have found that question. Well maybe.

Another good thing about it is you can save all your answers. Chances are you may need the answer again.

As far the format is concerned, you can't beat it. Almost every other forum I have been on for tech questions, for some reason I will never understand, they repeat the question like an email, so you have to read each question and answer in the subsequent post. Plus, so many times, I have seen these and there is a two month gap between answers.

One other benefit is that you sometimes make friends. In general, it is a rule that you can only email one of your favorite experts to a question. You can't ask them in the email. But, at times, you do end up getting into a conversation, and you end up with a Rob or a Raja. Raja is the gentleman who has help quite a few users on here with SQL. He has fixed a major problem with SQL on my server a couple of times. He remotes in and works his majic. Not free of course. So, over the years, I have met Gary, who is a home theater and computer guru, Rob, the networking guru, Raja, SQL, Tim, SQL, an Exchange guru, a SharePoint guru (who totally saved by [censored] from a staff mutiny. With most of these guys, I can just email, but obviously I do have to pay for remoting in. I already know that when I move Sharepoint to SBS 2011, I have my Sharepoint guy. Sharepoint is difficult to upgrade.

The format on EE is perfect, and there are moderators to ensure that no expert is out of line.

It's just hard to explain. If you are looking for a Tech Support Forum, EE is simply unmatched.

So, do the 30 day trial. Use it for a hard question. Show me the link, and I'll send the wine if it gets answered.

Just to be up front. Most of the time, an expert will answer in the time they have predicted like 32 minutes. There are times though that none of the experts like like question. And, keep in mind, forever reason, a lot of these guys are from England.

You can check the profiles on these experts. They will blow your mind with their experience. A tip to the wise: If you have an Exchange Question, then email Sembee2. The guy is an Exchange Server genius. Maybe the smartest on any given category. But, he can be a little rough around the edges. He also used to have, by far, the most total points on EE. Until he gave them away. And, then gave them away again. Like I said, he's a bit different. You can tell by his user name with the 2 at the end that he changed at least once.

Very, very intriguing.

My next question is: What keeps the "Experts" around? Do they get paid?

That is a GREAT question. It is ALL ego. And, some like on here just like to help. But, they get points. If you go over there, and I am not sure what you see if you are not a member, but all of the experts are ranked and have titles like Sage and Genius. Since I am a member I have 500 points to give on each question, which means I get a lot of responses. They are also graded.

So, it could be 500 points times 4 for the A = 2,000 points. Some get 30,000 a day. Now you can split the points. I almost always give A's as it is to my benefit. They check me out first and say, this guy has 520 questions, has accepted 510 (many askers just let the question time out, which the experts don't like and has given out 495 A's.

By the way, the answer to the question above meant the experts were wondering why the same four computers would go out even if the router was rebooted. The answer is the ARP table, where the router remembers the MAC address of each computer sort of like a switch. Weird, because the router should have let those go, but it didn't. Maybe a glitch in the router?

I"m just about sold. The problem with Google (and maybe the internet in general nowadays) is that there is *too* much information, much of it useless. Having a "go-to" place where all the content is relevant is really a big draw.

BTW, I Googled "Susan Bradley". She sells homes in the Lake Winnipesaukee area

http://msmvps.com/blogs/bradley/

She does that too, lol. Her website could be better. It appears she uses an iPhone unless she is making fun of it due to battery life.

The interesting thing about EE is that it does the Google and finding answers for you. Many times you will ask a question on DNS on a domain, and they will just say, "try this,:

www.dnsforgobruins.com

Agreed. EE is a great resource. You'll definitely get your questions answered there and also they will be a lot faster. Lots of them are specialists in certain applications so you'll get the exact answer.

If they can't figure it out, you can always come back here but I doubt that will happen.

OK, you guys talked me into it. Signed up for Experts Exchange. $99/year is a *small* price to pay for not subjecting yourself to aggravation for hours on end...

We have a computer on our network that I'm about ready to toss out the window. Freezes randomly. Who know what it could be. Could be RAM, could be software conflicts. I just want to swap it out, but be able to have the user see a familiar desktop when they log in with their new computer. Let's see how long it takes for someone to bite.

But you can keep the wine. I'm more of a Pabst Blue Ribbon guy, lol.

Criminy - there are people asking Power C# programming questions in there, lol.

I've been paying 12.95 a month for years to Experts Exchange. They answer at least one puzzler every month and it's a small price to pay compared to the $100 to $170 an hour the IT folks charge locally.

Well there ya go, Bert. You've started a grass-roots movement!

Okay, so this guy is suggesting that roaming profiles is how we keep the desktop intact. Do you guys agree?

Another guy is suggesting redirected folders is the way to go. My spidey senses are telling me that this is what I'm looking for.

Completely agree with roaming profiles if you have SBS and the capability. You could do the same by 1) doing a complete image of the machine or b)(very similar to roaming profiles) copy the profile to the server, then copy it back to the computer.

Basically this would be a one-time roaming profile. I googled this Microsoft article.

But, hey, I am not completely sure, so throw it on EE. They can absolutely tell you how to take the profile of one computer and put it on another.

http://maketecheasier.com/3-ways-to-backup-user-profile-in-windows-7/2011/06/11

http://support.microsoft.com/kb/214636

BUT, I THINK THE EASIEST WAY BY FAR IS:

Type "Windows easy" in Search Programs and Files and at the top,
you will see "Windows Easy Transfer."

With Roaming Profiles, the idea is the following.

On a normal desktop without roaming profiles, when you log off or close the machine, Windows saves the desktop and user settings to the local User Profile. When you open Windows again, it searches for the user and loads it again. So, on computer A, if you add five icons and change your wall paper and screen saver, etc. it will be saved locally but nowhere else. So, when you go to another computer and log in, you will not see the new wallpaper or icon, etc.

With Roaming Profiles, when you log into the computer, it doesn't look to the local profile, it looks to the server and grabs that user profile and loads it to the local user profile. Now, that computer will look identical to your other computer. When you log off that computer, Windows will save the user profile to the server.

In this way, the profile is always saved to the server and every time you log on it grabs the profile from the server.
_______

There is another very cool thing that takes too long to write her. But, essentially what you do is start off by making a temporary user profile on the server. It is set up in such a way that any time you make a new user account, it goes to that user account first, so you don't have to make the 50 changes that you normally have to do like change the wall paper and screen saver and setting on the start menu and any and only icon on the desktop. Even the "Display delete confirmation log" on the Recycle bin. In this way, you can set up a new user in minutes rather than an hour.

Since you can't isolate if it's a software or hardware issue. I would recommend starting fresh. Wouldn't want to copy the issue to the new computer. Just take a screenshot of the desktop and rearrange it if it's that big of an issue.

Another fan of EE, really not going to go wrong there. I've been having fun playing with server 2012 and virtualization, but just to throw out another opinion on ideal system, I think I would still say a good router and web based emr. Wireless, wired, network, domain, i7, atom, who really cares with the emr being web based. Over the last 12 years, other than a 3 day total utility outage from a severe storm, we have had ZERO internet down time... WAY better than any system I have yet to install. Just sorta waiting to see if AC starts to lean more towards web or not and biding my time. With all the changes coming in the medical field in general, it's really the only option that makes any sense to me. (of course this is the medical field we are talking about, where our main form of communication was invented in 1964, ie the fax machine). For the most part, whatever knocks out your internet usually takes out other utilities like power, water, etc, so you'll be out of commission anyway. I doubt they will "cancel" the internet short of nuclear war or the Zombie Apocalypse, and in that case, seeing patients will be the least of your problems!

Yeah, that's what I suspected Roaming Profiles did. I edited my post. This guy suggested "Redirected Folders". I think that's what I'm looking for.

I'm beginning to strongly suspect that it has something to do with Quickbooks and its #$#@& print engine. I think that's what's jacking up the print spooler too. There is some combination of QB, Adobe Acrobat Pro and MS One Note that just makes for a bad cocktail. But it's mostly QB's fault, if Googling results are any indication. If my hunch is correct, swapping out puters isn't going to help.

Prime 95 indicates that the puter is sound. I hate Intuit: their upsale policies, their half-baked code, etc.

I'm ready to unwind in a cool glass of PBR. Yee-Haw!

Lots of ironic stuff here. I love redirected folders, makes total sense. Roaming profiles is awesome when it works, but it has its inherent problems. Especially if you are logged into your office computer and say three other computers and profiles are roaming everying.

OneNOte. Best app ever. Nuff said. Except I hate 2013, didn't like 2010, so actually bought 2007.

Always good to start with RAM. Download Memtest86+ or Memtest+ and run it overnight. Graphics card. I would still back up the profile. Not sure how much good taking a screenshot would do. (sorry Sandeep).

Never knew this many used EE.

GoBruins post the link to your question and/or give the Expert's name.

Fax: Been around since 64, but the government still thinks it is more secure for Vicodin than ePrescribe.

In terms of hardware, first suspect is RAM. I'll let Prime95 run overnight, but in my experience, it'll halt in the first few minutes if there are hardware probs. The Kingston HyperX 3K SSD is next on my list, but it's generally considered a reliable part. Again, I think it's the bad cocktail of QB printing, Adobe Acrobat, and/or One Note. Google "Quickbooks printing error" - your eyes will spin like a slot machine, lol.

Here it is:

Link to Experts Exchange Thread

Nice. Looks like you are getting some good advice. I don't know the first expert. You can see why. Click on his username. He doesn't have a lot of clout yet. Still better than I, I would say.

The other is extremely ironic. (please keep it confidential though -- not sure how he would react if you mentioned my name).

Rob Will is a SBS and networking stud. If he says something, it's gospel. Click on his name, and you will notice he is an "Ace" in the SBS category. They have added some new categories, so I don't know if that is the highest. May sound funny, but it tells you how much to trust their answers.

I have known Rob a long time. The guy is good. Keep in mind if you have an SBS question or any networking question, you can email him through his profile and provide the link, and if he has time, he will likely check it out.

Yes, this guy is clearly a star.

Here are a few more questions that have befuddled me recently. Maybe I should post these as well:

1. Who will win the 2014 Super Bowl? Should I bet the "over" or "under"?
2. Should the Bruins fire Ben Howland?
3. Will I get the raise at work?
4. How do I know if my GF really loves me?
5. When will the AC PM module be ready?

In all seriousness - EE is everything you said it was, and is a bargain at $99/year.

Miami Dolphins vs Minnesota Vikings Dolphins27 -- Vikings 24 Over
Yes
If you own your own practice yes. If you don't, you won't, sorry.
He will buy you donuts daily.
Either one year or not at all. Pri-Med decides not do it and partners with Medisoft.

Not to intrude, but don't forget to award points if you feel you have the answer. Up to you, but if it were up to me, I would split the points, giving the most to Rob, but some to the other expert as he was rather helpful as well.

Even this many users using EE was a surprise. I can't remember how many times I have recommended it, but the user on here didn't try it.

Didn't know you could split points. I think I gave all to Rob. I "Robbed" peter to pay Paul, as it were.

BTW, you get *zero* points for your lunatic Dolphins prediction...

I'm not 100% sure, but I don't think SBS 2011 *Essentials* has Folder Redirection natively built-in. But, I think you can download and install an add-on to add that feature. Correct me if I'm wrong.

http://www.microsoft.com/en-us/download/details.aspx?id=27122

http://amazingcharts.com/ub/ubbthreads.php/topics/50276/Windows_Server_User_Files

That is correct

500 points for you, Sandeep! Bert - show him what he's won!

I just had a brainstorm - how about a Pay-Per-View cage match between Sandeep and Rob of EE...two brains go in, only one comes out. To the winner go the 2014 Superbowl Dolphins vs. Vikings tickets and a 6-pack of PBR.

I would say that when it comes to computers, it is Sandeep hands down. But, after ~ 3,000 emails with Rob, there are few that can touch him. He eats, breathes and sleeps DNS. Let's put it this way. His Ethernet fluke meter costs over $35,000. He did tell me he had a hard time deciding between the fluke meter and a case of PBR. I am guessing that is what his cost is.

We have so many questions on here about this and that being slow, etc. Sure, you can try with trial and error, but imagine using that meter and finding out the issue in minutes.