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Jon,

When I remote with my chromebook my double screen at my office desktop is replicated on my chromebook. So all I am doing in the office is controlling my main computer with the chrome remote desktop, in a singular fashion, which works fantastically.

I am not sure. My intuition tells me I can only mirror the double screen desktop and not split AC/Updox using the singular remote desktop. I have not tried the 2x remote desktop and this may be the way to go to achieve AC on one screen and Updox on another in a secure possible fashion.

Indy!!!! Help!!!

Alright, on my list to answer, but I have to ask, Jim - when do you ever sleep?

Our 1000 dollar spayed "free" barn cat, likes to scratch our leather couch or play the piano at about 3- 4am every night.

@Jimmie,

What are you doing with a piano and leather couch in your barn? Sounds a little kinky to me

The Queen is on a ROLL today.

I love it!!!!!!
Leslie is onto my hillbilly heritage/ways.

Jim may be manic, but we sure learn a lot from him. Keep it coming!

The only domesticated animals for multiple cat generations on the grandparents wheat farm, have been cats, wild, mean spirited, master mousers, to keep the bins free of them.

Several years ago the kids wanted to bring two home, and the only pair of kittens they could get within 100 feet were about dead already, so after 1000 dollars and a burial for Fluffy, and an eventual spay for Creeper, I have learned to finally like a cat.

So no mania, just "catamania" and all this middle of the night brainstorming only occurs so I don't let the cat stay out too long to freeze to death.

Ah, yes, the things we do for out cats!

Just an additional followup, have used the current set up in one exam room this week and there have been several unanticipated positive occurrences.

I am glad I went with the HDMI cable instead of the Chromecast to connect the chromebook to the big screen TV in the exam room. There is no hesitation between screens I noted with the chromecast at home, although I did not try the chromecast at office. But more importantly, I take the chromebook with me in and out of exam room and unhook from TV as I leave so the unintended rooming of patient with another's chart open on TV will not happen. With the chromecast I think there would be a higher likelihood for this to occur.

Also, I have only been thinking about the patient benefiting from the big screen TV chart, but found that with chart open while examining patient, I can refer to chart without sitting on stool and peering at chromebook on the 14 inch screen, so selfishly this has been an unanticipated improvement with efficiency.

Also the refill on a laser cartridge is about 50 dollars, and over time the savings on wear and tear of printers in each exam room and less cartridge use will pay for the TV's in about a year or two because instead of printing up graphs of BP,Weight, labs, can now do this visually. I use the plural as I intend to duplicate the setup in my second exam room.

Indy,

I got brave and connected up the Google cloud printing, which was quite easy to do and can now print on any printer in my office area with this app.

My plan is to use Google cloud printing only with non-PHI material, such as UpToDate patient information, printed to exam rooms. I can tab into UpToDate, print, and tab back to Chrome remote desktop app, and keep the PHI secure and separate, and reduce introduction of malware and viruses into my Microsoft desktop setup.

Probably overkill, but this capability exists to do this maneuver with this device.
Any issues that are problematic printing in this way?
Or would it be safer to sign out and print as a guest user for the non-PHI material?

Just ran across this article.

http://www.hitconsultant.net/2014/0...es-free-laptop-free-ehr-program-doctors/

My 13 year old son who came up with the idea of mirroring the patient chart from chromebook to the big screen TV, also helped get these pictures uploaded but had to do it with 2 separate pictures, but I think the pictures represent the set up nicely.
Also the patient information is a fabricated patient, used for display purposes only.

I do all my own medication reconciliations, and the improved efficiency alone with this process makes this setup well worth the investment.

I am able to bring up the med list and make corrections on the chromebook, while the patient follows along on the big screen TV, once all in order, I can print the med list out on paper. Before it was a multiple step process with at least 2 or 3 printings to get to the same end result.

The "My Favorite Martian" theme, is an additional 15 dollar one time investment so I can get 11 local channels, mostly HD and about half PBS flavored so patients can be entertained while they are waiting for me.

GROOOOVY!! (because of the mid-60s TV show reference)

Jump back Jack! James has got a brand new bag!

Can you keep your eyes on the TV while touch-typing on the chromebook? Is it sharp enough for that?

Obviously your chromebook display is too large for AC, so you might want the 11 inch.

Now that it's working, how would you improve it? Is the TV large enough? How far from patient's head? Is it 720i or 1080i resolution? How about a projector onto a screen?

Dan,

After your comment about Sandeep's logo as a reverse superman image, I had to spend about 5-10 minutes looking, and like a 3 D stereogram it popped, but I had never seen it that way before.

Well, your perception of the smaller AC image on the chromebook is a bit like you seeing superman with Sandeep's logo. I should have commented on this but really did not think about it till you mentioned it. However, using the singular chrome remote desktop (CRD) app, if I fully expand AC on my desktop, then it projects a bit fuzzy on my chromebook and TV screen. If I leave the AC the regular size on my desktop and click on the CRD tab up top to fully expand screen and fit to size screen, then the letters are crisp and clear and actually bigger and easier to read on both chromebook/TV and even easier to read than on the desktop.

The TV is a 24 inch Samsung 1080i and large enough. I have a moveable wall mounted arm, so I can move the TV any direction. First thing in AM I make sure the CRD settings are the same as before, and chart readable with TV facing me, if not just reset to the way it looks on the picture, then I know the TV image is easily read by patient, and then have it turned toward the patient either sitting in chair or exam table. My exam rooms are small and patients have all been able to read and follow along.

The screen on the chromebook is quite easy to read as I reconcile meds, order, prescribe or print up Up to Date material. And I do not look at TV when doing this.

I have the TV mounted, the base being about shoulder height and I am 68 inches tall. My patients sit off to the left of TV about 6 feet away in a chair, and the exam table is a bit closer to the TV than the chair.

I got a screaming deal on the TV -169 dollars, and have not looked at the cost of the projector, but at this point will be buying the same TV and wall mounted moveable arm for the other exam room.

...
Come here mama...and dig this crazy scene
He's not too fancy...but his line is pretty clean
He ain't no drag.
Papa's got a brand new bag ....

Dan,

After all that I realized I did not answer your question..."can you keep your eyes on TV while touch typing on the chromebook?"

Yes, and you can bypass the chromebook and make the TV your main screen, however, I have my TV mounted a bit high to make this a bit difficult to do for long periods of time. So if you want the big screen TV as your main screen, I would mount it lower than I did. However, my intention is to have the patient follow along as I chart in room, so mounted the TV at the most desirable height to achieve this effect.

Lenovo Chromebook: HERE

The TV is a Samsung T24C550, so you can google the specs.
I said 22 inch before but it is a 24 inch TV.

I have said that I have 2--27 inch monitors in my office, I measured diagonally and they are 22 inch and 23 inches, so I was wrong about those sizes as well.

I have had to develop two minor work arounds for HIPAA issues.

1. I minimize the main AC screen so if I inadvertently minimize the patient chart, no unintended patient information will be displayed.

2. I unplug the HDMI cable and then print up the continuity care document at the end of the visit, so to avoid displaying unintended patient information as well.

Maybe one of the tech guys could comment why the screen resolution and size of letters are better using the chrome desktop remote. I do not know why but I will take it.

Indy,

It is negative 33 with a windchill of negative 45. The solid state drive works in this weather.
My cat doesn't though...

Oh no, Jimmie....has he stopped playing the piano?

Balmy here, -14 with Wind Chill -25

Had to run a errand for the lovely bride last night and it was colder then; the 4-banger pickup started right up, but shifting was like stirring molasses and the hydraulic clutch keep sticking until the engine compartment warmed up.

Daughter's dog insisted on going, so I took him on the errand, and he usually wants to go for a stroll after the errand.

He quickly got hesitant and finally just laid down and started to cry, so I had to pick him up and carry him in. Quig could only teach him so much, he just ins't a working dog.

Creeper is okay, just getting "barn" fever being contained inside and too darn cold to be compatible with life outside. Scratching and making music more than usual at 3 am unfortunatley.

Indy you got yourself a head bolt heater yet???

Into my second week with the one exam room decked out with the big screen TV, and driving my nurse crazy. It started out this week with my bright idea of doing another practice wide broadcast with the Updox portal, which leads to increase busy work for my nurse. I am trying to avoid seeing patients in the exam room without the TV, so my nurse is having to room about half my patients twice, but the significant improvement in efficiency with engaging the patient with their chart open and going over trends with labs, weights, BMI's, BP's, medication reconciliation has been much better received than I ever anticipated.

I have had several patients or relatives of patients in the health care sector rave about the setup, and have felt a strange transposition of the patient doctor relationship. It's a bit like working on a school project together, a bit hard to describe, but being able to visually see the chart and help create, mold, and interpret it together, really engages the patient in a way I have never experienced before.

I was a bit skeptical thinking this may be a bit of a flop, but AC graphs and the Quest HL7 imported graphs of labs display quite well, and when the med list is expanded, extremely easy to read.

The e-prescribing with the drug interaction checker has been an unexpected hit, and the printer use has significantly declined.

Bottom line, I am definitely encouraging my partners to consider a similar setup.

Jimmie, you should post a video of it in action!

Sandeep,

With a fake patient I could do weights, BP's, BMI's, INR's, med list and med reconcilitations projections. But would there be a way to have fake HL7 imported labs to graph out like Cholesterols, LDL, HDL's, EGFR's HgA1C's over time? I think those graphs are the most impressive, but not sure how to do that without compromising PHI.

Another nice projection is scanned in items such as cath snap shot pictures of before and after stents.

Xrays too.

But I could do the non PHI related things, got to get my 13 year old to show me how to do a darn video, so on the to do list....... first got to get another samsung tv with wall brace if the weather allows a trip over the pass.

Thanks for the idea.

Jimmie,

Maybe you don't need the chromebook, just the TV.

http://accessories.us.dell.com/sna/productdetail.aspx?c=us&l=en&cs=04&sku=A7501067&baynote_bnrank=0&baynote_irrank=0&~ck=baynoteSearch

Dan,

One of my patients and I were just discussing earlier what technological gadgets will be available in the next year or two, when all this current stuff will be outdated.

Interesting device, and never heard of it.

I figure after the 129 dollars for the device, blue tooth key board and mouse, you would still need another tv or screen to mirror with to replicate the chromebook/TV scenario.

I think the beauty of the chromebook is the cost, functionality, ability to mirror your desktop with the chrome remote desktop app. Surf the net detached from the chrome remote desktop to decrease malware viruses, and bang it back and forth between exam rooms and home, but the projection of the chart in real time while futzing with it involving the patient is probably the most beneficial unintended consequence of this whole exodus.

2 unrelated and unplanned events resulted in this breakthrough, the genius of Indy telling my wife who told my partner to buy one for me, because I am such a tight wad I would not have for myself. And the flexible out of the box thinking of my 13 year old son to mirror the damn thing to my TV.

I am out 35 dollars for an unused chromcast which grovels me a bit, but I ain't complaining.

Dan, thanks for the heads up on this and I will have to read more on it.

Got the other room outfitted with the same setup.

I have had several other observations with the TV/Chromebook setup, such as inputting intake information on a new patient is much easier than taking notes and doing this later in my office.

Also, sensitive information, better placed in the confidential section, can be better directed by patient if he sees something he does not like in the records.

Of course hindsight is 20/20 but wish I had done this a long time ago.

The first picture is my other exam room, and the second is sitting on the exam table looking at the TV with the weights graphed out. This of course is a fake patient for the sake of demonstrating the set up. The TV is on a mobile wall mounted arm and can be positioned in most any direction for better viewing.

I have never figured out how best to integrate the 5 minute clinical consult, part of the knowledge base, which pops up when that button clicked.

I have generally gone to UpToDate, printed up handouts and gone over material.

The back pain information is a bit weak from up to date, and with the projected screen have finally found a good use for the 5 MC material, and had two low back pains back to back today, and found the material much better than with UpToDate on this issue.

Projected on the TV the 5MC information is a very useful format to work through together.

Interestingly one of the patients today manages multiple farm implementation/parts stores throughout the region and several months ago incorporated two screens, one turned toward the customer and one turned toward the employee while filling orders/servicing the customer at the counter, not unlike this system. He was impressed with the similarities, and has had positive feedback since implementing this system from both customers and employees.

After about a month of using the Chromebook as a thin client mirrored to the 24 inch TV screen I have a few more observations.

This is getting a bit tangential to the Chromebook theme, and has more to do with the projected AC chart image. I have been pleasantly surprised how well AC projects, and wonder if the initial designer had this feature in mind, not to necessarily have a patient look over your shoulder on the computer screen, but rather projecting AC onto a screen and being able to manipulate the AC chart with another device while the patient actively participates. If not, he sure hit a home run in my opinion.

I initially surmised the elderly medicare complicated patient would be overwhelmed and not interested in this interactive use of AC. However, I have noticed a trend otherwise and the older more complex patient seems to be more appreciative and involved than I ever expected.

This particular setup has added a whole new dimension to the functionality of AC, and significantly improves efficiency and patient satisfaction, and quite frankly I never saw this potential of AC, until stumbling into it.

I forgot to say it. But, thank you very much for the images, Jimmie. I'm sure many will find it invaluable when looking to improve the layout of their exam rooms.

Sandeep,

I hope to get a video made at some point, but have not had a chance, and my 13 year old just got my nurse hooked up with a double screen monitor lay out this weekend. I was watching my nurse train another nurse on her computer about a week ago, and I never realized the number of times spent minimizing AC, Lytec or Updox to carry out her work. The cost of not buying some of this hardware, and the resultant decreased efficiency has to be fairly significant over time. It is having the eye to see it and then the brain of a 13 year old to figure the solution. Ha!

I was at the ultrasound suite at hospital this week and interestingly, that department is using a large screen TV with a wall mounted arm so the patient can watch the images as the ultrasound tech does her thing with the screen on her machine.

If you read any of the throw away journals the single biggest patient complaint with the electronic record is, "the doc has his nose in his computer and won't even look or talk to me." I use this as an ice breaker to the big screen TV projecting all their woes and ills, and usually say that we both can have our noses stuck in the electronic record together.

I appreciate all your help over the years, Sandeep, but I will tell my son, because he is the one who got the pictures to "take". I could not figure out how to post the pictures after about an hour of struggling and he did it in about 5 minutes.


I forgot to mention, my son found a use for the chromecast. He can stream movies from his Ipod onto the big TV in the basement, works like a charm.

Thank you for your insight. It's nice to have some real life confirmations of what Bert and I have been trying to tell people for years.

That's why I've been trying to tell people that higher productivity comes from better workstations. I know the whole tablet/iPad/chromebook craze has people wanting to convert, but it just doesn't make business sense. High productivity comes from multi-monitor setups. It just makes logical sense to use them with applications such as Amazing Charts. Most likely, you will also need to access hospital portals, various websites, shared folders, faxes, etc. If you want some empirical data, see below.

Studies conducted by Dell, Georgia Institute of Technology, and University of Utah all basically showed the same thing. Dual monitors can boost productivity tremendously. The Utah study showed you can get an extra 56 days of productivity from each employee every year. Employees with 17-inch laptops (which are pretty big by laptop standards) were the least productive and the least pleasant to use. Imagine what they would say if you gave them an 11 inch chromebook. When people buy extremely small tablets/laptops for their employees to work on, their employees probably don't like it and it slows them down.

All of my employees have at least dual monitors. This is why many business people disliked/don't see the point of the Metro Interface of Windows 8. A start screen designed to run one app at a time really just defeats the point of a workstation. My personal sweet spot is 3 monitors. I have a 4th but it's just running surveillance/other static items.

I can also post some useful apps to use in a multimonitor setting in my blog. Stay tuned.

Sandeep,

I may have you try to convince my nurse about the improved productivity with dual monitors. She was ready to skin me alive coming in on a busy Monday without any warning from me and trying to figure out what the extra screen was for.

However, my guess is by the end of the week she will be skinning me alive for not doing this sooner.

But my son wanted to tell you, you are welcome and you have a "really cool" website.

Once you go Bi do you go Quad????
Yep love dual screen even though takes up more desk space.

Haha. That's the thing. You want to implement in such a way that it's like having 2 separate computers. For instance, I use DisplayFusion with my multi-monitor setup which gives me a taskbar and a start button on each screen. So I have the ability, to manage, launch, and use programs on each screen independently. You also can have things like hotkeys that can move windows to the other screen with the press of a button.

I'll try to get some video as well of some of the exam room layouts I've seen as well as multi-monitor usage.

Tell him I said "Thanks!". Good to know I can still connect with the teenagers. One thing I find amusing is that people think that the live chat is an advertisement but it's actually me/my staff on the other side. Some people have also been clicking the Call Me From the Computer and surprised to see it dials our phones here. It's a cool feature for people who have laptops with built in mics/webcams or Dragon users.