Home Forums Discussions General Discussion Suggestions for networking with offsite exam rooms (say what?!?)

Hi all,

My wife is a solo FP in a practice we designed around being as affordable as possible (for patients, that is). To that end, I manage the "front desk" from home while my wife sees patients in a very small office space a few blocks from our home. The office includes a small waiting area and two exam rooms (with not so much as an additional closet). We like it that way but it has posed some tricky technological dilemmas. We both need access to the same incarnation of AC but we are necessarily operating from totally separate internet access points. This is truly a low budget operation (partly because we are committed to keeping costs low for our strictly self pay population and because it's a new practice and we're still in the pinching pennies stage of start-up) so the solution has to be cheap.

Our current method (which doesn't work) is to share a laptop. Yes, we share it. (c: I keep a printed copy of the schedule at home and call/text updates to her throughout the day. She takes care of faxes and portal messages between patients when she's got the computer and I clean up the loose ends when she's home. That was a great plan when she was only seeing a few patients per week and I had the laptop when she was at her other gig in a large group practice. Now she's working exclusively at her new practice 5d/wk and the faxes/messages are coming in way faster than she can keep up with alone and it's getting harder and harder to keep up with the phone calls etc when I don't have access to AC during business hours. We're not busy enough yet that everything has come to a screeching halt but I think we're quickly approaching that point.

My initial plan to initiate some semblance of simultaneous work flow is to set up a desktop (already own) as the main AC computer in the backup exam room at the office and buy an inexpensive laptop for the primary exam room. I'll access the desktop (with hidden/turned off screen) from home via GoToMyPC or some other similar service.

Should the office LAN be wired or wireless? The space is already wired for a LAN but that would keep my wife tied to the corner of her rather large primary exam room (12x15). I've heard that setting up an appropriately secure wireless network is a bear. (Can it really be that hard to securely network two PCs and a printer?) The laptop in the primary exam room would generally stay in that room but she does make house calls and I don't like the idea of having our main computer bouncing around town even though we have offsite backup. If she makes a house call on the way home, the office laptop would likely spend the night at our home and be returned to the office network the next day.

What hiccups or confounding circumstances does anyone foresee?

Is there a better way (within the constraints of our crazy business model)?

Any suggestions are much appreciated!!

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BTW, for those who are curious, every single patient has been enthusiastically supportive of the fact that, as often as not, I have to interrupt a phone encounter with a patient to tell my 4yo to hold his thought, play quieter, be nice to his sister (8mo), or fetch a paci to help keep her quiet. (c:

set up a wireless in the office, don't broadcast it and have a good passphrase key is good enough
on the other hand AC has never been able to sync well when I take my laptop out and return and I've given up and just have a separate database for my out of office patients
If there is good 4G in your area and you don't mind the dataplan prices you could get an adapter for the laptop and link into the office main computer that way

Would you then recommend not taking AC anywhere (such as on the laptop) and instead logging in through GoToMyPC or something similar? Any security concerns with doing that?

You will of course need internet access. But that's what I do every day. I use LogMeIn, which has a free version with no time limit, and "Pro" version $70/year. GoToMyPC is 30 day free trial and $99/year.

No, very secure connection.

Because of the database sync issue it is better to take laptop and log in either LogMeIn (I use this) or Go to my PC, you will need good DSL or cable internet for connection speed; the advantage is everything goes into the one database

Tim, to expand on a couple of points:
I believe a few people successfully use the "sync" function, but most on here find it to be unreliable (if there are happy sync users out there, please speak up). This means that when your wife takes the laptop, her only other choice is to keep the one AC database in the office and log in. That works well, though as pointed out above, she must have internet access (e.g. from the patients' homes) to access AC.

Keep in mind one other limitation: only one person can use a machine at a time. For example, if you log in to the laptop, she cannot be using it simultaneously. If you create a wireless network in the office, she will be logging in from the laptop to work directly on the server (which in itself is not an ideal practice), but you will not have access to either machine at that time. Similarly, if she is out of the office using the laptop to log in to the server, you will have no access. I believe the solution will require either a wired network in the office OR buying another machine.

Most modern cellphones can be set up to act as a wireless hotspot for your laptop in a patient's home or elsewhere. LogMeIn is very useable to access your AC database in the office in this way.

Current Setup (Please correct if otherwise):
AC on a Laptop - Wife has it during business hours. You have it afterwards.

Recommendation:

• Get Desktop - Move Database to It. Make sure this is a good one. Windows 7 Pro 64 bit, 8GB RAM, i5/i7, etc. Setup Remote Access using LMI/RDP. Use concurrent sessions tweak to have concurrent users logged in meaning you can both we working remotely. Demo here: https://www.youtube.com/watch?v=l4bAlp52z1A
  Well-Priced Examples (There are better ones, but these are available fast):
  - Lenovo ThinkCentre 0958B2U Desktop (Free 2 Day Shipping Fast (Amazon Prime), Windows 7 Pro, i5-2320, 4GB RAM, 500GB HDD)
  - Acer Veriton DT.VC5AA.002 Desktop (Free 2 Day Shipping Fast (Amazon Prime), Windows 7 Pro, i7-2600, 4GB RAM, 500GB HDD)
  ==>+4GB RAM is $20
• Keep the extra computer at home - Since you will be working remotely, the speed of your computer is irrelevant for the most part. Just get a good size screen. You could use that desktop you already have.

You will have to be extra careful since you will be working directly on the server. Your wife can either connect via LAN (wire) to access AC using her laptop or via WiFi to the main computer over RDP. As I said earlier, you will have to be careful with working directly on the server. 100 FT cables are $10. She could keep the wire where she usually likes to sit and get a cart for the laptop. Just get 2, one for each exam room.

When she is off-site, she can either use remote access or just keep a note in a plain text file and copy it to AC later (encrypt or something too). I wouldn't go through the hassle of setting up 4G and all that if she's seeing only one or two patients on the way home, sometimes.

When you are at home, you can use Remote Desktop and it'll be as if you're sitting in the office. Not a bad idea to get Skype on your computer as well as her laptop so you can communicate.

Once the practice gets going, you can get a proper setup.

Great info from everyone. So, let me see if I can sum up a reasonable plan of attack in laymans terms.

Plant a dedicated beefy server computer in some hidden corner of one of the exam rooms (since the waiting room is probably a bad idea) that will not be used as a work station at all. Have two workstation computers on the office wireless network. Wife uses one to see patients and I remotely log into second workstation to take care of front office business. When wife is on a house call (presumably after-hours anyway) she accesses #2 workstation remotely from the laptop she usually uses as #1 workstation while I enjoy a break from front office duties. I can't imagine not having access to AC and e-prescribing while on a house call and I definitely want to avoid any sync difficulties.

We've been using Clear for our internet. It's unlimited 4G internet service for $50/mo with excellent coverage in our metro area so when she needs to make a house call, she just takes the hot spot with her. The device has an internal battery so she just leaves it in her bag for house calls and never messes with setup. I'm seriously considering keeping our current WiFi hot spot for remote access needs (front office and house calls) and purchasing a second line of 4G service for the intra-office network rather than mess with landline service.

That about sums it up. You could also tweak workstation #2 so you can both work on it remotely simultaneously, if necessary. I'm glad you decided to have a dedicated server/main computer. Reduces a lot of IT headache. That's good that you already have a 4G hotspot. You should try to get a fixed line (Cable/FiOS/DSL, if possible) at the office if you plan on continuous remote access.

Remote desktop - "teamviewer" has worked well for me for off site work.
Have it installed on my clinic workstation (not on server)
and have a client installed on my laptop.
AC stays on the server and runs on the clinic workstation.
My laptop accesses the workstation and I am in business for free, with three layers of passwords !
Here is the link -
http://www.teamviewer.com/en/index.aspx

(This has worked much better for me than
Logmein and / or Google-Chrome remote desktop (also a free add on to the chrome)

I use logmein...the reason i chose this is to be able to use logmein ignition which is the android version and can access my charts on my phone.

TeamViewer is free for non-commercial use. If you use it at the office, you probably need to buy the base license which is $750.

LMI Free and Remote Desktop are free to use commercially on the other hand. I still have no idea how LMI still offers LMI Free for commercial use. Central is a great value for IT people too. I have over 100 computers on my LMI Central. But I still think Remote Desktop is better suited for work-related activities.

I use both continuously on a daily basis.

I love TeamViewer because you can reboot the computer and it will advise you when its back on and it even boots into safemode.

Google Chrome remote desk top is much simpler is FREE, but not as versatile as team viewer tried both out.