Home Forums General Back Up and Restore Question

I am a new user of Amazing Charts for two weeks in a small Rheumatology practice, and like it so far.

I have read the posts on backup issues, and I can't find the answer to this particular question.

What specific files need to be backed up? I tried making a copy of the AmazingCharts.mdb file to a flash drive, then pasting it inside the AmazingCharts folder on another computer (overwriting the one already there), and it seemed to work and contain the entire database. Is this the only file that needs to be backed up, or should I be backing up the entire AmazingCharts folder?

Also, along the same lines, if I am resotring AmazingCharts on a computer, should I only paste the copied back up AmazingCharts.mdb file into the AmazingCharts folder, or should I overwrite the entire AmazingCharts folder with a copied AmazingCharts backup folder?

If this has been discussed in another thread, sorry and please point the way.

I am just trying early on not to have any catastrophies.

Thanks for the help,

-Lee

We should takes this to problems but if you are unsure or just want to make back-up real easy for others who may have to do it in your absence then yes just copy the whole darn AC folder to the drive or location of your choice. There are five that are most important, but if you have things like labs activated and the like you may actually need that as well.

As I have posted for others in the past we have two drives that we copy the entire AC folder to every night (this way you get copies of any back-up files that Amazing Utilities has run in the past too, see sometimes simple is best, I've got my solid reasons) to both drives. One comes home with us in our laptop bags while the other stays locked in a fire and water proof box, locked in our med cabinet.

Every now and again I make a folder with all the back-up files AU makes, so the original AC folder doesn't get too big. They have names like BU AC db and the like, you'll be able to tell them apart from the originals. Then I make two copies of that folder to the two drives. Carlos suggested this to me many years ago as a decent housekeeping idea. Keeps that original folder tidy and from getting too large every time you run AU's.

Always have some sort of off-site back... Just in case. Loose your entire office you still have your data. Have to evacuate the entire region (Katrina style), grab that back up drive and take it with you. Heck in that case email the entire thing to another AC office in another part of the country. Not too HIPAA but at least you tried to keep a safe copy of your data, Heck email it to yourself as long as your email sits in like the ISP's servers until it is safe to go home.

Bert, I'll email mine to you. Actually send a copy of your database to tech support in a real emergency, just in case. Carlos here it comes!!!

Thanks hockeyref for that reply. I assume the 5 files that AU makes a backup of are the 5 essential files?

One further question. If I am backing up my AmazingCharts folder every night, do I still need to run AmazingUtilities for the backup? (If I should, how often do you run Amazing Utilities?) What is the difference between the AU backup files, and the original files which I have copied as a backup? For example, is BackUpAmazingCharts.mdb any different from AmazingCharts.mdb, or is it the same thing just with a different name?

By the way, that is a good idea to store the AU backup files somewhere else, they have been taking up a lot of space in my AC folder. I didn't know if I could remove them without something bad happening.

Thanks again,

-Lee

Not sure about all your questions but some guys like to run AU a lot and use those as their back-ups I think, and I think but I'm not sure that yes they are identical but for the name. I believe AC recommends like once every week or two. I know it is time when everything starts crashing or freezing. Now the database needs a bit of housekeeping from AU. Also the updates run a form of AU and make pre update backups as well. But I backup my file before taking any updates, just in case just as the utility warns you to.

So after I run AU I usually do about a weeks worth of back up that now have those back up files in them, then I cut them out into the special folders I make to store them in on the machine, and then I copy those to my back up drives as well. I usually make one or two of those folders per version of AC according to how long in between updates from AC and the ones I rush to take or wait out and don't take right away. So I've got a few 3.6 ones now and I just ran AU tonight as a matter of fact because we have had two freeze ups of AC in two days now and so I felt it would be a good idea to clean up the system before I leave town tomorrow morning to go to Clarkson University for NYSAHA ice hockey official's camp for four days. Now hopefully the office will run smoother in my absence... We can hope right???

Lee,

Yes, backups have been talked about in many threads. I am not sure why AmazingMeds is not backed up as well with AU, but I am sure because it doesn't change much if at all. For me, since I edit it nearly weekly, I back up also. You can certainly certainly only back up AmazingCharts.mdb IF you want to lose your schedule, any added codes, your billing, and worst of all, all links to imported items. So, if you had 1,000 imported items on 500 patients and you lost your ImportItems database, you wouldn't be too happy.

You have also not mentioned your Imported Items themselves. Do you import or not? If you do, then they need to be backed up. This folder will grow very fast.

The bottom line is, it makes a lot more sense to back up the entire folder, then you don't have to worry about it. The only reason, AU makes backups is in case the tune up procedure screws up your databases. Then you have back ups. Unless you have a way to set a path to where these go (you don't), then they are rather useless sitting in the AC folder. There is no advantage to using them over backing up the folder or just the plain databases. The backups are exactly the same, and if you renamed them, they would work fine.

All your questions are good ones, but they will do you little good if you are only backing up to a thumb drive. Please back up to better storage that you keep at the office and keep multiple, multiple backups. I keep at least a month's worth and then go back over a year. Take one home at least weekly.

Thank you both, hockeyref and Bert, for the comments. This forum alone is reason enought to get AC. As we speak, I have purchased two external hard drives, both of which will be backed up to nightly, and also I will burn the AC folder onto a CD/DVD each week to take and store at home. I also think I'm going to buy the offsite backup utility. It doesn't sound like I need it, but $250 isn't really a lot in the grand scheme of things, and I'd rather be extra safe.

To answer Bert's question, I haven't started importing yet, but have been writing letters to the referring doctors, which I noticed goes into the Import folder. I hadn't realized this folder existed, thanks for pointing it out.

This next (and hopefully final) question sort of has to do with the back up issue.

Up until now I have used AC on my laptop, which I take home. I am now ready to take the next step and put it on the main computer at the office, and network with it from my laptop. If this goes well, I am going to purchase a server for the office and further implament it. My question regards how to change the main computer for AC for a group of networked computers.

This is the plan I have come up with, please tell me if it will work. I will install AC on the new main computer at the office, then delete the AC folder in the new installation and replace it with my most recent backup AC folder. Then, un-install AC from my laptop, followed by a clean install, but linking to the main computer in the set-up phase.

Is this a good way to transfer the main computer for AC from one to another (in this case from my laptop to my main office computer?) Speaking of this, do you also have a backup computer or server to run in the event your main computer crashes with AC, so you can get your charts up and running quickly?

Thanks again,

-Lee

OK, one at a time:

As far as backups, there are a million different ways. It sounds like you have a good plan. Two external hard drives should be fine. Just be sure to alternate, so you do a Monday backup on Drive 1, then Tuesday on Drive 2, Wednesday on Drive 1 and so on. This will mean the following Monday will be on Drive 2. This will ensure that if one drive goes bad, you will have a much better chance that you will have a newer backup. Remember, the weakest part of any system is the hard drive. I would recommend doing a manual backup and having some type of automated backup like Acronis or Backup Assist. You could manually do the folder, while doing a FULL backup of the computer.

Offsite backups are great. And, there is a big advantage of doing them. Never do them on the "server" computer. Always do them on a client. This will send a copy of the server's databases to the offsite story AND make an encrypted file of all six databases on the LOCAL client. So, now you even have more security. And, if you were to take those home, you have encryption.

Your plan would work, but it is much too difficult. First, you need to know AND I need to know if the "main" computer will be used in the office to run AC. If you can afford it, it would be good if it did not. If it does not, then do not download and install anything. Simply copy and paste the AC folder from your laptop to the "main" computer. Share it. Then all of the other computers can browse to it. As for your laptop, don't uninstall and reinstall. Just leave the AC folder there, and change your path. You can do this one of two ways. You can use AU to change your path. Or you can do what I prefer. You bring up AC on your laptop to the sign in window. You right click just below the name of your company. This will bring up a window allowing you to reset your path. You do. Then, you choose the radio button on the bottom part and browse to your shared folder on the "main" computer.

If you are planning on using the main computer as many people are forced to do given finances, etc. Then you will need to do as you say. Download AC, delete the folder, then copy and paste the folder from your laptop to that main computer. Then do as above resetting all the other comptuers and browsing to the main computer. Again, there is no need to delete the AC folder on the laptop or reinstall. Just use the AC program that is there. If you want to be extra careful, you can go to My Computer, C: drive, Program Files and Amazing Charts (assuming that is your path), go into the AC folder on the laptop and change the name of the AmazingCharts.mdb file to AmazingCharts.old. This will insure that it is impossible to connect to that by mistake.

To answer your last question, just go to:

http://www.amazingcharts.com/ub/ubbthreads.php/topics/9630/2

I just use a batch file to copy AC everyday to the computer I have decided to use as a backup server. If you really want it to be ready, you go ahead and share the folder. If you REALLY want it to be accessible, you map that shared folder to each client. So, by running the batch file every night, you have essentially a completely up to date AC folder on a backup computer, which you can access in seconds. You don't have to use the batch folder, although I can write the code for you if you give me the two locations (main AC folder and where you want to copy it to).

A couple of other ideas to ponder:

Seagete makes a personal server for real time backups called a Mirra. I have two of them. You cannot physically move files to it. You simply install the software, and then choose what files and folders you want to backup/monitor. So, you can choose My Documents, Outlook, etc. Here you would monitor the AC folder. Now, you would have nine of the latest databases. It would not be a backup solution per se, but it would mean that if the server crashed at 2:10PM, you would have the 2:09PM database. Granted backing up a 60MB folder to a 500GB Mirra is a bit much, but you can back up anything to it as it is networkable. So, all PCs could backup their files to it. You can also access it from anywhere in the world.

Mirra: http://tinyurl.com/596por

Your idea of burning CDs each week is great. It will work perfectly for you. Just use CD-R and not CD-RW. Much safer. And, you can keep all of the CDs way back for a year. There are reasons for this. If you find you get tired of burning CDs and ultimately paying for them and marking them and buying plastic cases for them, you can think of the following which I do. You could buy an 80GB to 320GB Seagate Go or WD Passport. Below is an 80GB mobile hard drive which is a very good price. You could literally backup 1600 AC folders on it. It is larger than a thumb drive so you probably won't lose it. And, it is smaller than an external drive so it is portable. You can also get them encrypted.

Passport: http://tinyurl.com/5fbsj4

Finally, while Amazing Charts uses Access and is NOT truly a client server application as it will be with SQL, a real server as you alluded to with a client/server setup and domain/active directory is definitely the way to go. Certainly, a P2P is fine and this is argued on here all the time, but in my mind a server environment using real server software is best. Remember, a lot of debates on here are based on whether P2P or server/client is the best for AMAZING CHARTS, but users do not take into account the entire office environment. For me, I look at it as the entire network and how I want to network Medware and FAP and AC and everything else. I want redundancy and speed and easy backups. I want a very fast and very redundant and secure server that no one ever uses and/or touches. The advantages of a server (when I say server I mean a true server machine with Windows Server 2003 or my personal favorite, Windows SBS 2003 R2, are too many to list.

Bert,

Thanks again for such a detailed and thoughtful post. I had not realized you could just have the AC folder on a computer without the AC program and have other computers access it. That makes a lot of sense.

There is a lot of information in your post and I will be re-reading it and digesting it over the weekend, as well as trying out different scenerios.

On Monday I have a local IT support company comming to the office to discuss what we want them to do. Currently, we have 9 independent PCs running XP (actually one has Vista) and 5 thin-clients running off of a Mysis Server. (We have recently been unhappy with Mysis and are now switching.) They IT company is going to help us get the office ready for AC (wireless routers, firewalls, setting up a network, etc.) and we were going to discuss whether we needed a server.

Based on the post above, it seems like having a server is the way to go. It will also let me use my thin clients to run AC without having to replace them with regular computers.

I will continue to re-read the post above and post back an update.

-Lee

Lee,

Thanks for the kudos. A couple of suggestions based on my experience, and I think Adam will back it up.

Thin clients are OK. BUT, remember all the computing power in the AC environment needs to be on the client end. The server does too but it is not like using Oracle or SQL even though that may change. But, you have to run AC on each computer so on a computer with a small processor and no RAM, you will not get good performance. So, fast processor, lots of RAM (2GBs - dirt cheap) and not much hard drive space, although try finding a drive at least than 80GBs.

Some advice on IT. MAKE SURE THEY LET YOU WATCH EVERY STEP OF THE WAY. If not, don't go with them. If they don't teach you, then they are looking for job security. Think of it as asthma. If you want good job security, you don't teach them the difference between Flovent and albuterol. You will get followup appts like that, but you will have unhappy patients. You want to be involved in the processl. Let them know you want them as CONSULTANTS and not as the people you have to call when you need to add a new user or change Active Directory. Actually, an Active Directory change may be something they would do. Try to pay by the hour when you need them and not a contract.

Here's the deal. This is a bias I have found with all IT people from yours all the way down to me. There are two biases. Think about it:

1. IT people will try to push you in a direction they are comfortable in. So, if they are comfortable with Windows 2003 Server or 2008 but don't know diddly about SBS 2003, they will advise you to go with the non Small Business Server.
2. IT people including myself (and I am not claiming to be an IT person at their level) wil try to live vicariously through you. Example: You say, Bert, set me up with a server, and I will set you up with a RAID1 for operating system, a RAID5 for Data, with the RAID5 configured with four drives with a hot swap and a hot spare. Why? Because that is what I want. Think about it.

Now, having said that, no matter what they tell you, please think about Small Business Server 2003 (either Premium or Standard) R2 rather than just the Windows 2003 or 2008 Server. SBS is awesome when it comes to small businesses and can do really cool things for way less money. The regular Windows Server is for huge corporations, you wouldn't see SBS in a hospital. But, if you bought Windows 2003 and you wanted Exchange Server now you are paying $1,000 more. SBS comes with Exchange, it comes with ISA, it comes with Sharepoint. Sharepoint is the most incredible piece of SBS. Windows 2003 Server doesn't have it. When my IT person told me about Sharepoint, I was like yeah wow, who cares. Now, I couldn't live without it.

SBS also allows Remote Web Workplace, the most secure way to remote itn. You can remote to all desktops, the server, Outlook Web Access and more. It's awesome. Just go to some of the posts on here (many) about remote access and everyone makes great points, but with SBS you won't need RDC, LogMeIn, GoToMyPC or VPN and it is more secure than all of them.

See, I am already pushing you towards what I have. But, I would be glad to answer questions about all of them.

One more thing about IT. Before they come in, know about the server OS, and thin clients, and desktopss and Cat6 and 1GB switches and 1GB network cards, etc. or you will be at a disadvantage. And, I am not saying they will try to do that. But, also, my IT guy five years ago sold me a Cisco with ten licenses instead of 50, and it took me two months to find out why five computers intermittently wouldn't access the Internet. And, the guru didn't know either.

Oh, and feel free to call me anytime with questions. I will post in PM.

Up until now I have been using AC on just one computer (Vista OS).

Tonight I have tried installing AC on a secondary computer (XP)to see how newtworking works.

I shared the AC folder on the main Vista computer, installed AC on the secondary XP compter, and found the shared AC folder during the initial settings. The Log-In screen came up with our practice name, so clearly the connection worked. After logging in, initially is said login successful, but then the error message appeared:

"Amazing Charts can't write to the database at this time. This is usually due to one of three possible problems..."

One of the problems listed is that the shared folder might be set to read only status.

On the main computer, when I click on properties of the shared folder, under the "Security" tab, when setting permissions it has the following groups mentioned:

CREATOR OWNER
Authenticated Users
SYSTEM
Administrators
Users
TrustedInstaller

I have "full access" granted to Authenticated Users and SYSTEM. Do I need to have it set to full access for any of the other groups, or is there some other setting I need to change?

The other possibility is that it says my network connection might be intermittently down. When I explore the networked AC folder from the secondary computer, it moves super slow. For example, when I open the shared AC folder it takes a second, but when I hit the back button on the browser it takes 22 seconds to close. Could this be the problem?

Thanks,

-Lee

I just gave full permission to USERS, and the same error message.

AC on the secondary computer also starts super slow. I wonder if it is my network setup, but I also want to make sure I've shared the folders correctly.

Any thoughts?

Thanks,

-Lee

Lee,

I am assuming that when you go to share the folder, you are right clicking on the Amazing Charts folder and choosing "Sharing and Permissions."

If you do this, you will click the radio button for Share this folder. You, of course, enter the share name or accept the default one. Choose Maximum allowed. At this point, you HAVE to click on Permissions and in the Permissions for "name of share" you will see Everyone in the window. Make sure that Full Control, Change and Read are checked under the Allow column. By default, it will only have Read checked.

Has nothing to do with the slowness. But, it is ALWAYS the network. But, this isn't due to the overall network, just how you are sharing out the folder.

Ahhhh.... grin.

That worked. It looked a little different on Vista (Sharing radio button, Advanced Sharing button under Advanced Settings, then Permissions Button.) I had been clicking Full Access under the Security tab. I guess that is something different.

It is a great feeling when something like that finally works. Thanks.

It still is a bit slow. About 12 seconds to pull up a patients last note, 5 seconds to close out of it. Is hanging a bit. I am at home with two laptops on a G wireless router at 48Mbs. Is this expected? Is this something that would run a lot faster if I networked off a server (like your Windows SBS)?

Thanks,

-Lee

Lee,

Glad it worked. You said you are using Vista and XP. Is this XP Pro? And what version of Vista are you using? I believe you said you are usng the XP computer to host the databases and running Vista as the client connecting to it. Is that correct? In your test scenario where XP is being used as your "pseudoserver," are you running any other programs?

Also, no matter what you do, wireless (at this point in time) will always be slower than wired (depending on your speed of the wired). If you are running Cat5, you will be getting 100MB speed if everything else is set up correctly, and Cat6 will give you 1000MB or 1GB although you actually end up getting ~ 400MB speed (again depending on your setup, i.e if your switch is 100MB, then you will only get 100MB).

You can experiment easily with a two computer setup. Go to Best Buy or Circuit City or Staples and pick up a CROSSOVER cable not a plain Ethernet cable or patch cable. With a crossover cable you can connect directly from NIC card to NIC card. If you use a non-crossover cable you would need a switch or hub. You can then test speeds by making a large test file that is 1GB in size. Then transfer it from one computer to the other using wired and wireless.

The other problem with wireless is you will lose your connection to the database intermittently even if only for a second or so, but just long enough to jeopardize your note possibly. You shouldn't, but it happens. But, you will still get popup messages.

To answer your question about using a server such as SBS, you won't find yourself getting that much more speed. There will be less bottlenecking and better throughput, but you probably won't notice that. The best part of the server is one, you can put your money into a super fast processor and 4GB of RAM if it is a 32 bit OS. You can go up to 32GB of RAM or so with a 64 bit OS, but that is a whole different creature. Plus the RAID configs will give you faster read/writes depending on which RAID you choose. Of course, you get much better redundancy.

Finally, on your clients if you really want speed after you have set up Cat6 cables, switches and NIC cards, you can install the new WD VelociRaptors. Those things smoke. I get almost three times faster transfer speed along wtih other improvements. But, it is $300 plus for a 300GB drive. Well worth the money if you are looking for more speed. I must confess I only have one on my own computer and not in the rooms. I am thinking of adding two more.

Oh and by the way, 12 seconds to open a note is NOT acceptable. Maybe you can put up with it, but I can guarantee your staff won't.

Bert,

Sorry for the delay in post. I have VISTA premium on the main computer, XP professional on the computer I'm am trying to use as secondary.

I met with IT yesterday. The problem with the network turned out to be with authentication. They recommedned my useraccount name and password be the same for all computers I am linking (for exaple, username AmazingCharts). When I did this, it connected quickly, and now I can not tell the difference between the main and secondary computer in terms of speed. I'm sure there are other ways to do this, but that did work.

I have wireless set it, and it is working well. I likely will be ordering a SBS server.

Do you know how flexible AC is? I'm trying to collect data on my patients. Mainly, for all patients with Rheumatoid Arthritis, I'm wanting to record 4 variables (a function score called a mHAQ, a pain score, a patient global score, and a summation called a RAPID score.) I see where you can export non-identifying information. It would be great if there was a way I could record those variables in fields, and export them as non-identifying data. I am working with researchers to study things like funtional outcomes related to lab tests and medications. I was hoping I could add fields, like where the vital signs are, to do this. Do you know if AC would offer any such capability?

Thanks,

-Lee

Lee,

I am glad they got it work for you. I didn't really think of that. They must both have the same workgroup name, but then they wouldn't have been able to connect at all if they didn't.

Once you get a server computer and run SBS, you will be setting up a domain as the server will be a domain controller. At that point each computer will have its own name and, therefore, its own FQDN (Fully qualified domain name). So, if the computer is named Reception01 and your domain name is "Nameofoffice.com," then your FQDN will be reception01.nameofoffice.local and the domain name of your network would be nameofoffice.local.

I am guessing your IT people will help you set up SBS. I doubt it will be something you will want to do yourself if you have never done it. It isn't that hard, but there are a few things you want to get right the first time. The experts (I am not one of them) will always tell you that most errors from networks are due to the server's not being set up correctly the first time.

Remember, ALL your computers that are XP MUST be XP Pro. You cannot connect XP Home to a domain. You can connect it to a network that is a workgroup but not a domain. There is a workaround, but it is obscure and certainly not a viable solution. You can mix and match Vista with XP, but personally I wouldn't. I would do one or the other if only so you don't have to remember different ways to do different things. They will work together. I am still an XP guy. And, there are also only two or three (I think three) versions of Vista that can connect to a domain.

If you do decide to install SBS yourself, here are a few suggestions. Small Business Server 2003, a DVD put out by Train Signal is incredibly good. Second, if you did it completely by yourself, you can always instll a virtual machine on your PC such as VMWare and install it over and over. Just don't activate it. You could network it and do anything you would do if you had it on its own server. If you need any help at all, don't hesitate to ask.

As for the data, let me sleep on it.

Hi Bert,
Going thru your posts, which I learn a lot from by the way, it looks like you use Medware for billing.
I use Medware too for my solo part time Int.Medicine/Noninvasive Cardiology practice. From what I know, as AC does not integrate with Medware do you do double Entry or have found a work around for billing ?

Thanks

Raj,

Supposedly, Jon is going to come out with a fully integrated practice management program. This is not necessarily going to be part of version 4. To make a practice management program is a huge endeavor. I am sure that the code for Medisoft, Lytec or eMedware must be rather extensive.

I have always maintained that given the inaccuracy and redundancy of the ICD-9 and CPT codes in Amazing Charts, it will take quite a long time for me to trust AC with my billing.

So, yes, I guess we do double entry. I still do a paper superbill (I guess you could say it is our one point of not being paperless -- although we do scan them in). We tried printing out the superbills, but it just wasn't doable.

Ironically, on the W/E when I see patients by myself, I don't make up a Superbill, I just print out the Superbill/Invoice on AC at the end of the visit. But, I find it a bit cumbersome, because one would think you could click directly on the Print Encounters / Send Letters to bring up the Superbill window. But, instead, I am forced to click out of that window, bring up the patient (easy to do when I am seeing the patient myself since the name is right there in the patient list -- but not so easy when my nurse has pulled a chart and forwarded it to me) it is no longer readily available. So, then I have to find the name and right click and click on Superbill. It seems so obvious to put it on the window which pops up after the sign off.

I have found many workarounds, but it seems a bit dangerous to have to do workarounds for billing.

It is interesting that you bring up eMedware, because I would think that many on here would have a third party billing program. And, yet, all anyone talks about for backups is backing up AC. Backing up your .TPS files in eMedware is just as important.

Bert,

I think I have dragged this post out for a long time, and since I keep changing topics from my original backup question I should probably start posting onder other topics with more pertinant headings. With that said, things are going very well thanks to your help.

I began using AC by myself on my desk (the only doc in a 5 doc practice wanting to embrace EMR). This weekend I am putting computers in each of my two exam rooms to have nurses enter meds and vitals, and now feel comfortable setting that up. In about a month, when more patients are entered, I am going to put a dedicated computer at the nurses station and have them do phone notes on the computer instead of paper charts. It is a slow integration process, but I see it becomming a reality. I think maybe 6 months and maybe I'll be close to paperless. I am using two hard drives for backup, and will probably try that Seagate thing for minute to minute backups.

One final question on this thread before I started posting on other threads. The most irritating problem right now is that when I am dictating (using Dragon Medical 9.5), about once every two patients suddenly the cursor will jump to the height field. I can't figure out what makes it do it. Sometimes a loud noise, but sometimes right in the middle of a sentence and I can't figure out what word I am saying that triggers it. It is most annoying to be in the middle of a long sentence in the HPI, and suddenly I see the cursor in the height field, and all of what I said is lost. It appears that something is triggering voice navigation to do this. Any thoughts on why it is happening, or how I can turn off this feature, or voice navigation completely so this doesn't happen?

-Lee

Lee,

Great job. I am excited for you. I think you will find that even though it does take a lot of time, integrating computers and software with your practice will make it much more productive and fun. Using Sharepoint form SBS and the Internet with Lexi-Comp and eMedicine and UpToDate, etc., I can practically fix the patient in the room right there.

Just a suggestion, but maybe you won't like it. My nurses triage my patients in triage and forward the chart to me. That is not my suggestion, lol. They do all of the subjective stuff and the vitals. Now, they may write, "Johnny presents today with fever. He is taking Tylenol and Dimetapp." But, I don't allow them to actually enter medications. I always do that. I don't think they can fully interpret what the patient is telling them and how to write it. For instance, if the patient says he has heartburn and is taking Zyrtec, they may write in Zyrtec where you would know he or she meant Zantac. Also, one thing I ALWAYS do no matter how far behind I am. After reading the HPI and saying hi to the patient and retaking the HPI/ROS, etc. I always double click on the medication list at the bottom left and go over their medications. Are you still on this or that? How is the Prevacid working. It keeps the medication list tidy as I inactivate those that are not being used or change the dose for those who decide to change doses without telling me. Plus, it reminds me quickly of what they are on.

Get that computer for them as soon as possible. Like tomorrow. At first they may be a bit overwhelmed, but eventually, they will love sending messages through AC and documenting everything. Our rule is basically if you talk to a patient, you better write something. They want an appointment, write it in the scheduler, they want to talk with me, send me a note, you tell them to put A & D ointment on, you write a note to that effect and save it. If a patient tells me my nurse told them to put on sunscreen or I overhear her telling them to take 0.8 mL of Tylenol, I will look every so often to see if it was documented.

As for the DNS, I doubt I can help you there. Sounds like a bug either with AC or DNS. Have you tried the latest version? Or have you tried going back one? Anyway, I emailed Brian Cotner who is the DNS guru to see if he minds if I give you his email address. I can't imagine that he would say no.

It's the word "in", which selects the button marked "in", in this case the abbreviation for the word "inch."

So, without further ado, here's the answer to the "inch bug"

http://amazingcharts.com/ub/ubbthreads.php/topics/3126/Dragon_Naturally_speaking#Post3126

Thanks Brian! Did you come upon this yourself or did you get my email. Either way, thanks, but I hope you came to our rescue.

Brian,
Thank you so much for that fix. It worked. I do like the safelty of not being able to execute a command without saying "click." Every once in a while a nurse walks up behand me and speaks loudly, or I sneeze or cough, and I always get a bit nervous about it interpreting that as a command. Thanks again.

Bert,
That is good advice about the medications. I do find that whenever I take a shortcut, I end up regretting it. Perhaps I should enter the meds myself.

I have started taking some phone notes on AC, and I like the fact that the recent ones pop up first if they occured after the last visit. Very often in my paper charts a recent phone note gets placed beneath a dictation (as dictations take a week to get back, if the patient calls before the dictation is back it gets out of order), and I embarrase myself in front of the patient for not having seen the phone note. For example, I might say "How is drug X working?", when a phone note indicates the patient called in with a symptom that caused me to stop drug x.

I probably should start my nurses doing phone notes now. I was waiting until I had a decent percentage of patients in AC, so they wouldn't have to stratle between paper charts and AC. But the more I ease into AC, the more I start using it.

Thanks again for all of your help,

-Lee

You will be much happier when you do all of your messages in AC.