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by Naeem - 03/18/2026 10:38 AM
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#59057
12/17/2013 10:02 PM
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One of my partners unexpectedly got me a Chromebook and wondering about integrating this in office. Any experience or suggestions??? 
jimmie
internal medicine
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Depends on how you want to use it - you can use as it as an additional 'laptop' if you use M$ or third-party terminal services.
They are light - power-up quickly, and are easy to use/maintain.
We have clients who have their MAs/nurses use them for vitals/chief complaint during the rooming of the patient.
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Indy,
Thanks, I like to remote in with my laptop using logmein to power my main machine, so I do not have to sign on and off taking my laptop into exam room. So I think this Chromebook will work nicely for this use. Although the clarity or crispness of the screen may be an issue, so will just have to put it to work tomorrow and see.
Hey we got up to 56 above today!!!
It is an impressive little gadget.
Three additional questions, is the Chromebook inherently safer than a laptop used in this fashion, and also would the 2x Remote desktop app work better than logmein, and any suggestion for an antivirus?
I cannot believe the number of free apps available.
jimmie
internal medicine
gab.com/jimmievanagon
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Does Google track use of the Chromebook apps, etc, in any way? I would be concerned about privacy issues.
Doctor Mel
Family Practice, FAAFP
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Bought a Chromebook some months ago after hearing Indy praise them (I am pretty sure he and Larry Page are tight). My use has been at home, though I an interested to hear about office use. I do use logmein for checking charts, eRx from home, etc. Would be nice if there was an ignition app.
Having a Chromebook is sort of a poor-man's MacBook. Like a Mac, nearly instant on, thin and light, excellent battery life, relatively free of virus-risk (I use AVG free). At a cost of about $250, it is hard to fault them.
My wife loves it, too... she spends about 90% of her laptop time either on the internet (including shopping, banking, etc) or with email. Throw in Google docs for word processing and the Chromebook is an inexpensive laptop alternative that meets most of her needs. Love that it boots up in less than 10 seconds.
Jon
GI
Baltimore
Reduce needless clicks!
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Jon,
I got clobbered today in the office, but was able to remote in with logmein. The screen is a bit small but my 13 year old computer genius showed me how to expand the "field of play".
I would like to try the Chrome remote desk top app, because the letters are a bit fuzzy.
I think it could be used as a back up at this point, and I like the keyboard better than my HP elite notebook and it is a lot easier to carry to and fro.
More later, I am starving and better get out of the office.
jimmie
internal medicine
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Does Google track use of the Chromebook apps, etc, in any way? I would be concerned about privacy issues. ALL app stores report some level of app usage to developers; amount varies. Unless you choose to save a document off-line, nothing is retained on the machine. From a patient/privacy perspective, using an encrypted connection addresses part of that. If you don't want someone/proxy in the transmission, use a direct-connecting technology (e.g. RDC, 2X) .... and this will *seem* obvious, DON'T SAVE YOUR PASSWORD in the app. Really.
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Indy,
..... Hey we got up to 56 above today!!!
It is an impressive little gadget.
Three additional questions, is the Chromebook inherently safer than a laptop used in this fashion, and also would the 2x Remote desktop app work better than logmein, and any suggestion for an antivirus? The Chromebook may very well work better in temperature extremes because of the solid-state drive. The next time it gets -20 or better I'll take one outside and see how it does.
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Bought a Chromebook some months ago after hearing Indy praise them (I am pretty sure he and Larry Page are tight). I can neither confirm nor deny ..... But I am in the Google Glass explorer queue as a developer
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Indy (and anyone else),
Thank you for the answers. If you have time would you mind commenting how the Chromebook works in a virtual environment as compared to remoting to an onsite server.
Also, is there a species of Chromebook that outperforms another? I have the Acer 11.6 inch.
I cannot keep the kids off the darn thing, so have not gotten to do much with it yet.
jimmie
internal medicine
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Thank you for the answers. If you have time would you mind commenting how the Chromebook works in a virtual environment as compared to remoting to an onsite server. It'll be the same thing. Virtualizing is something IT people like to do to consolidate workloads. In most servers, CPU's are under-utilized. With virtualization we can combine workloads that would typically take multiple physical servers. We get more bang for our buck when we consolidate. You also get other benefits like the ability to move servers easily. The 2X client is just like Microsoft's RDP client. Remoting into a physical server is no different from a physical server. It's the exact same thing.
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A couple of extra thoughts:
By having the Chromebook in the office, I can get my "internet fix" without utilizing my office laptop and main computer for this function. This will add an additional layer of security.
Thinking off the cuff, but having one or two of the Chromebooks in the break room for staff use, may decrease the risk of inappropriate internet surfing while working. Allowing use of the Chromebooks in such a fashion, for a minimal cost, may reduce the likelihood of malware or virus introduction into the computers designated for work.
Any one doing this already or have any other thoughts?
Also,Sandeep, if I understand correctly,by virtualizing the Chromebook, one can have a 200 dollar "portal" into a kick butt processing system to more than handle the AC/Updox needs of everyday practice.
jimmie
internal medicine
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This also seems perfect for those of us using AC in the cloud. Updox, occ internet, and AC in the cloud is all we use the exam room laptops for. hmmm
Bill Leeson, M.D.
Solo Family Medicine
Santa Fe, NM
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Bill,
My only major concern is the screen size using it with AC in the exam room. I think if you increase the field size, it may not be optimal, but doable.
jimmie
internal medicine
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Don't some of the Chromebooks come with 14" screens? Would that be enough real estate?
Gianni
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Gianni,
HP has a 14 inch screen but the price goes up to about 300-350 dollars I think, and a 14 inch is enough real estate, as I am currently using an Elitebook 8460 that has a 14 inch screen in the exam room, and I have the progressive lenses in my eyeglasses, with the gray hair as a complementary feature.
jimmie
internal medicine
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A couple of extra thoughts:
By having the Chromebook in the office, I can get my "internet fix" without utilizing my office laptop and main computer for this function. This will add an additional layer of security. Almost all attacks ultimately are OS based, so you insulate yourself from 99% of the existing attacks. Thinking off the cuff, but having one or two of the Chromebooks in the break room for staff use, may decrease the risk of inappropriate internet surfing while working. Allowing use of the Chromebooks in such a fashion, for a minimal cost, may reduce the likelihood of malware or virus introduction into the computers designated for work.
Any one doing this already or have any other thoughts? This is the least expensive way to protect your practice from infections unless you implement an edge device(router/firewall) that proxies your internet and filters content. One of the benefits of a more advanced edge device is that you can get email alerts on infected download attempts of unauthorized content [e.g. FaceBook, Youtube, p0rn)
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This also seems perfect for those of us using AC in the cloud. Updox, occ internet, and AC in the cloud is all we use the exam room laptops for. hmmm Increasingly popular for folks on our managed environment who what a full keyboard, 'instant-on', and low cost/maintenance. One potential drawback will be how you do printing - works better for some than others depending on work-flow.
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Don't some of the Chromebooks come with 14" screens? Would that be enough real estate? The screen quality and size have improved with each generation - the 14" ones seem to work for most folks who are comfortable with using laptops now.
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Jim,
There are two methodologies for connecting with a Chromebook.
<1>Replicate the desktop - Chrome remote desktop - useful in moving from your office to an exam room while staying in one chart
<2>2X [or similar] - separate session from your desktop - two charts up at the same time
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Indy,
I am excited to try the Chrome remote desktop, as staying in one chart, for my workflow, works the best.
If this app pans out, before I buy another Elitebook from HP, I can buy 3 14" Chromebooks for about the same price.
There are several features that are significantly improved over the Elitebook, the rapidity of powering on and off, durability with the solid state drive, portability, and of course price.
I can now understand more fully your interest, and thanks for the earlier discussion at Laramie with my wife regarding this option.
We have a gift exchange at our office where we pick a name in a hat among the partners, and just found out their was some collaboration when the partner who picked my name called my wife. Thanks to your discussion she gave him this excellent suggestion for a gift.
One additional question, for the 14 inch Chromebook, do you recommend the HP Chromebook or HP Pavillion, or is there much difference?
jimmie
internal medicine
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Found a 14 inch HP Pavilion Chromebook at Staples for 279 bucks, because I got tired of wrestling the 11.4 inch ACER Chromebook from the kids--so once I figure out how to remote in with Chrome remote desktop, I will let you know how that works Bill--
jimmie
internal medicine
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Jim,
Drop me a mail/text when you have time and want me to remote in and do it for you.
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Indy, Thank you for the offer, but my 13 year old Chromebook genius got it figured out. I cannot thank you enough for this advice, the Chrome remote desktop works much better than the logmein app. Instantaneous, and much crisper screen resolution. I can run Updox and my printer, order electronically, and access Up to date, by the way I have my main computer configured. So in reality, the Elitebook is an overpowered tool for the way in which works best for me. And that is with the 14 inch Chromebook, remoting in and running as my main computer when in the exam room. I am not sure if seeing the bull moose and couple of cows in Vedawou or this tidbit of information is more exciting, but the latter will keep me in business longer. I read ecg's remotely from time to time and this was very easy to do on this 14 inch Chromebook remoted in from home without difficulty, so I think the screen size has enough real estate to be effective in the office. 
jimmie
internal medicine
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One additional feature of Chrome remote desktop compared to Logmein, is that with my double 27 inch screen, dragging between fields feature is much nicer on the Chromebook. Otherwise I would have to go to top of page and click, and with a hesitation the other screen would pop up.
This is not a major deal, but all the subtleties added together, make this remote feature of Chrome much nicer.
Whether intended or not, when printing script from AC to Updox, the little bar at the top with the Chrome remote tab does not get in the way. However, when closing charts or expanding this tab at top sometimes gets in the way but dragging the screen a bit gets around this bother.
jimmie
internal medicine
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One other question I have for anyone who cares to comment regards the HIPAA implication if the Chromebook is ever lost.
With the Chromebook using it as an extension of my main computer, I will not have any patient records or charts on the device. I am only using the Chromebook to remote into my main computer.
So if I had the unfortunate experience of losing the Chromebook used in this fashion, would there be a HIPAA breach?
jimmie
internal medicine
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One other question I have for anyone who cares to comment regards the HIPAA implication if the Chromebook is ever lost.
With the Chromebook using it as an extension of my main computer, I will not have any patient records or charts on the device. I am only using the Chromebook to remote into my main computer.
So if I had the unfortunate experience of losing the Chromebook used in this fashion, would there be a HIPAA breach? Jim, The easiest step is to make sure that you aren't saving passwords @ log-on, so that said, you have settings in the Google account where you can disconnect a given machine (lost, stolen, taken over by kids, etc.) Another option to consider is to use 2X to make connection so that you aren't using the Google remote desktop - there are tradeoffs. Another option is to setup another Google account that is used only within the practice - then setup that account on the Chromebook and your desktop; keep everything separated.
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Indy,
I like the 3rd option the best. I really like having the Chromebook running my main computer. My workflow is designed best with this method, and my main computer is directly linked to my nurses computer and scansnap scanner, and also runs my 4 printers.
This is the first day I have been running with the Chromebook, and working better than logmein. No hesitation, screen sharper, sign on easier, and the dragging between the screens much easier.
I am suggesting all my partners think of this option as a way to interface in the exam room, as it appears to be quite financially palatable, and very functional.
Once again, thank you for the feedback, and I hope you and Lori have a fantastic New Year!!!
jimmie
internal medicine
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Just 2 additional observations with the Chromebook.
The scrolling on the touchpad with two fingers is much more intuitive and better than on the HP laptop.
Also, I have played with team viewer a bit in the past but the cost is so prohibitive I could not afford it. Also, I really do not see any advantage of team viewer over the Chromebook remote desktop feature, which is free.
jimmie
internal medicine
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My 13 year old son inadvertently made me realize the Chromebook function as I have thus far envisioned has been quite narrow. One can plug the HDMI cable into the big screen TV and mirror the Chromebook screen, and read ecg's. By using google file, one can store on the Chromebook or in the cloud, a slide presentation created with Google slide, which is like power point. So one can do a presentation, with or without the internet, as long as one has a projector with an HDMI port. One of the main reasons I went with a laptop instead of desktop was limitation of space in my two exam rooms. Thinking off the cuff, one could easily mount a wall screen and if xrays, graphs or labs needed to be visualized easily, plugging into the Chromebook and mirroring could easily be done. I have not had a need for this much at all, but this feature does open up possibilities I had not thought of. I apologize if most of this is evident to others, but just trying to catch up to the 21st century! 
jimmie
internal medicine
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Bill,
I noticed on another thread that you use Mac products. The Chrome remote desktop is fully cross platform. Provides remote assistance to Windows, Mac and Linux users, or access Windows (XP and above) and Mac (OS X 10.6 and above) desktops.
jimmie
internal medicine
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Jon,
As you alluded to earlier, the Chromebook has uses outside the office as well. My wife has created her own user sign on, with her Gmail account, and can modify the bar and apps to her own needs. So for instance she downloaded her pottery pictures on our home desktop to her Shutterfly account with her Gmail address. On my 14 inch Chromebook, she signs on to her gmail account, connect to Shutterfly and works on updating, modifying the presentation of her pottery stuff for on line clients.
So in summary, the HP Pavillion Chromebook has fulfilled a nice niche at home and office. It is great to remote in to my "terminal server" at work and improve efficiency at office by manipulating with the secure and excellent remote desk top application. For my work flow running the Chromebook like my "terminal server" in the exam room considerably improves efficiency in office.
At home, my wife can do her thing without impacting my exclusive gmail account accessed through the same Chromebook.
I think this device has a place either at home or office or both, and for the price, I think it is well worth it. So hopefully, I have not steered anyone in the wrong direction, but this is just my incessant rattling on regarding this product to hopefully help anyone toying with the idea of purchasing one or not.
jimmie
internal medicine
gab.com/jimmievanagon
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I have started using a 14 inch tablet android from home using remote desktop
Connected via Logitech Bluetooth keyboard
Satisfied so far with efficiency
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Sunil,
Would you mind sharing the cost of the Android and what remote desktop app you are using?
Also for anyone in the know,
My understanding is that with Chrome remote desktop, it is encrypted using SSL/TLS and is considered HIPAA compliant. Am I wrong in this perception or understanding?
I understand microsoft word remote desktop is not HIPAA compliant unless using a VPN. Is that true?
jimmie
internal medicine
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Microsoft Remote Desktop is encrypted, and depending on several factors you can decide what level of encryption you are going to use.
RDC is a point-to-point protocol (direct), so you can do it on the same network segment, or use port forwarding to transverse firewalls, routers and such.
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Indy,
So whether one uses Chrome remote destop (RDC?) or Microsoft, both are encrypted and secure for transfer of PHI? That is my understanding from what you say above.
jimmie
internal medicine
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Price on black Friday $199 on tiger direct. Likely $250 now. AAlso price in $49 for a bluetooth keyboard. (I Had a spare one I had bought for my ipad a few years ago)
Using Microsoft Remote desktop to connect while in office and also remotely from home or secondary office.
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Thanks Sunil
jimmie
internal medicine
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jimmie
internal medicine
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My guess is that the Lenovo Chromebooks will be aimed at the consumer market. Cloud is taking over the market. Doesn't matter if you have a public or private cloud. Mobile apps are becoming more powerful/featured. If the feature set is lacking, you simple remote into your personal computer for a fully featured program.
High powered mobile devices are pretty much used by business/commercial users nowadays. People who need fully functioning machines on the go or have high security requirements that mobile devices do not provide.
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Sandeep,
So in your opinion is there any difference using log me in, windows remote desktop or chrome remote desktop using either a regular laptop/desktop from home versus using a chromebook with any of these connections?
From my research, I cannot find a difference but if you care to comment I would appreciate it.
jimmie
internal medicine
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Microsoft RDP leverages a few benefits over Chrome RDP. Microsoft's RDP protocol is better integrated with Windows as such it can work better with lower bandwith. Unlike most remote access protocols, it can pass information regarding specific windows and whether or not they've been updated which results in reduced bandwith. LogMeIn/VNC etc simply pass the full screen. Microsoft's RDP can also adapt to your resolution, sound, and access your local printers. Printing is a big one where Chrome RDP still needs some work.
In summary, for the mobile user, either one will suffice. Chrome RDP/LogMeIn/TeamViewer/etc. will do the trick on the go. However, if you are looking to replicate your workstation (e.g. printers, monitors, etc.) at home or some other fixed location (e.g. a second office or multiple offices). Microsoft's RDP is the better choice.
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Sandeep and Indy, Thank you both for all the fantastic information!!!!
jimmie
internal medicine
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You're welcome
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One other thought that is running around my brain is to get a couple of cheap flat screen TV's with HDMI ports for each exam room, get a couple of Chromecasts and then as I am remoted in to my AC with the patient, they can watch on the TV screen which will mirror my opened chart in exam room. I think this can be done fairly inexpensively. But would there be any security issues using a Chromecast in this fashion?
jimmie
internal medicine
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Go for it jimmie!
Just make sure the other exam rooms aren't getting your show.
Dan
Rheumatology
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Dan,
I have not purchased a Chromecast yet, so your point is well taken!!!
I hope to be able to mirror one TV at a time, if not I will just have one exam room with the TV.
jimmie
internal medicine
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To me the best plan would be having to bring only one chromecast with you from room to room, but I don't know how long or difficult it is to start up when you come into a new room. That may be easier than switching connections on the chromebook with a different chromecast in every room.
The problem is in occasionally forgetting, whether it is forgetting to remove the device or forgetting to switch connections to a different chromecast on moving to a new exam room.
Dan
Rheumatology
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Dan, I like your idea better than mine I think I will head to Staples and get one and try it out a bit, and give some f/u later.
jimmie
internal medicine
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Jim,
I got a Chromecast last week, so have only played with it a little.
Your Chromecast device will have a number when you set it up. When you ask the computer to cast to a TV, you pick the correct device. So, I think if you had multiple Chromecasts, it would not be a problem. It would be a bit of a pain to move the Chromecast, it needs to be placed into the HDMI port and connected to a power source, either USB or a regular outlet. The Chromecast uses your wireless network to receive the input from your computer.
Donna
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Donna,
Thanks for the input. Just got my 13 year old Chromecast/Chromebook genius to help. So I just started experimenting, but can remote into office and AC shows up nicely with the Chromecast device plugged into big screen TV at home.
I agree, if I do end up getting flat screen TV's in both exam rooms, switching out one chromecast between 2 TV's would be too time consuming.
I would be able to sign on, I think, and pick one or the other chromecasted TV's, with the icons up in the right tab area. However, I am not 100% sure about this. But this would require keeping the chromecast (2), one in each TV and choose the correct icon to mirror AC in the exam room.
There are some Chromebooks that do not work with Chromecast, but my 14 inch HP pavillion Chromebook works.
Now it is time to stream in "Lilyhammer" on Netflix to see which poor Norski Frank "the fixer" will corrupt tonight.
jimmie
internal medicine
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Donna,
I forgot to mention the Nerd Herd geek at Staples told me that unlike the Apple TV the Chromecast streams directly from the cloud and your mobile device acts as a trigger, whereas Apple TV runs the content on your mobile device and will drain the power more quickly.
jimmie
internal medicine
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I tried casting Netflix from my HP Pavillion 14 inch Chromebook to my big screen TV last evening. It is easier to get Netflix up and running compared to streaming in with the Xbox or Wii. However the picture is choppy, not ready for prime time in my opinion. I have been asking my patients this week about implementing a big TV to mirror chart viewable in exam room. I think most would rather prefer the old fashioned approach. At this point I am scrapping the idea but I doubt the current Chromebook/Chromecast combination would work as well as just plugging an HDMI cable into TV/Chromebook and mirroring by pushing control and F4 button. It sounds like one can use apple devices to cast with Chromecast now. http://www.macrumors.com/2014/01/15/google-play-movies-ios/
jimmie
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Jimmie,
There are two ways to view Netflix through your Chromebook. In one, you open a tab on the laptop, you to Netflix, and stream. The second is to use the Netfix app on the Chromebook. The second way gives a better, less choppy picture. Which way were you doing it?
Jon
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Jon,
I went to the app store on my Chromebook and "downloaded" the Netflix onto Chromebook. So I then clicked on app icon and then clicked on Netflix. Signed in to Neflix, then clicked on the Google cast tab in the upper right hand corner of screen. It seemed doing it this way the screen on the TV was a bit fuzzy, not crisp and would be a bit choppy, but doable. Later I just streamed Netflix onto my screen of the Chromebook, and it was crisper and not choppy, better quality.
I casted You tube onto big screen TV from the same Chromebook the other day and it was just fine.
jimmie
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While visiting the in laws 70 miles away realized there is no 3G with the 14 inch HP Pavillion Chromebook, so if you are on the go a lot there are other Chromebooks with 3G capability. Otherwise, I suppose you could tether to a smartphone to create a wi-fi hotspot, if you want internet capability. Without the internet, the Chromebook is about as useful as a capon around a henhouse.
jimmie
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Jim,
You must have gotten the HP 14 inch with wi fi only.
For only $50 more, you can get the HP 14 inch 3G version which includes 2 years of T mobile service, although the data cap is 200 mb/month
Donna
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Donna,
You are right, the 14 inch Pavillion HP I got does not have the 3G. I have had it for about a month, and this is the first time I realized not having 3G could be an issue. So for me who travels very little, it is not an issue.
For only 50 dollars more, I may consider it though when I get another one.
The 14 inch screen, solid state drive with quick upstart/downstop, and great remote desktop function are the big selling points for me. It works great at office and surfing the net at home, and watching Netflix up at grandma and grandpas.
I am a bit excited to see what Lenovo churns out in the next 6 months and may be the time to upgrade to the 3G model.
jimmie
internal medicine
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I am trying to understand the cloud managed concept in conjunction with a Chromebook better, so if my office lost internet capacity/electricity with my future Chromebook with a 7 hour battery/3G capacity, I could see a few patients in my Vanagon out in the parking lot as long as I am in range of the Verizon towers and get cell service.
So by having my whole practice managed in the cloud, I could still function with 3G, a bit slower, than with the internet in a power outage but still somewhat functional.
And even better, wherever I had internet or 3G access, I have a "portal" to my entire practice, so whether in or out of office, with my Chromebook or desktop I can manage and run things.
Am I grasping this correctly?
jimmie
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Donna,
You are right, the 14 inch Pavillion HP I got does not have the 3G. I have had it for about a month, and this is the first time I realized not having 3G could be an issue. So for me who travels very little, it is not an issue.
For only 50 dollars more, I may consider it though when I get another one.
The 14 inch screen, solid state drive with quick upstart/downstop, and great remote desktop function are the big selling points for me. It works great at office and surfing the net at home, and watching Netflix up at grandma and grandpas. Jim, One of the option is using your 4G/LTE phone to provide network bridging to your Chromebook. When I am on the road and need connectivity, I have been known to drive to where I am getting decent signal [top of an off-ramp] and connect via my phone. Two cautions; you need to have your phone plugged in because using it as a data modem eats battery, and that sucker is going to get HOT if you need to stay on for a while. But it works.
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I am trying to understand the cloud managed concept in conjunction with a Chromebook better, so if my office lost internet capacity/electricity with my future Chromebook with a 7 hour battery/3G capacity, I could see a few patients in my Vanagon out in the parking lot as long as I am in range of the Verizon towers and get cell service.
So by having my whole practice managed in the cloud, I could still function with 3G, a bit slower, than with the internet in a power outage but still somewhat functional.
And even better, wherever I had internet or 3G access, I have a "portal" to my entire practice, so whether in or out of office, with my Chromebook or desktop I can manage and run things.
Am I grasping this correctly? Jim, you are correct about the core concept. Network connectivity becomes essential, but power becomes much less of an issue [battery operation, backup power, power converters]. Ever since a client had the unpleasant revelation that Amazing Charts backup service consists of no more than 6 backups, we have seen an uptick in clients having us archive and curate their backups. This accomplishes both long term storage as well as enabling us to bring that client up from their last backup in the event of a catastrophic event [hurricane, fire, flood, theft, etc] or an extended power outage. We can then transition them back onto their local equipment when they are ready to resume operations there (or a new location).
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Indy,
I hope that the issues of backup, surviving a disaster, etc., will be a topic for discussion in San Diego. I am extremely interested in that as well.
Doctor Mel
Family Practice, FAAFP
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After about a month of use in office, I have to concur with the assessment put forth by robtweed. http://robtweed.wordpress.com/2013/12/19/chromebooks-the-ideal-healthcare-desktop/P.S. Near the end of the article the term "crosh" is used. What does this mean and is it a way to connect securely to another computer?
jimmie
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How easy is it to attach a Chromebook to two monitors?
Jon
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jimmie,
I don't have any experience with chromebooks, but I think it has two meanings.
1- a stripped-back terminal OS shell client (known as crosh), with OS for operating system, so think thin client
2- a man crush toward a chromebook requiring possible intervention
Dan
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Dan, Thanks, just trying to wrap my mind around the functionality, realizing it does have limits. I have been more impressed with it as a secondary device to interface with the patient more so than I had expected, or maybe I am still in the titillated stage!!! Jon, I think this might answer your question, but I have not tried it out. http://www.geek.com/chips/chrome-os-update-brings-dual-monitor-support-1529496/
jimmie
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I need a laptop for my office for my staff to input information [and not being locked to a desktop.] So as I explore options, let me ask this:
1-Does the 'remote desktop' chromebook use a dedicated user account on a pc ?
2- Can multiple users be signed onto different chromebook units [can you run concurrent sessions from a single pc?
or, maybe I should ask, does a chromebook replace a Laptop running MS Remote Desktop Connection ?
Roger
Working Hard for the children in the community.
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Roger, I think yes to all of your questions. I would recommend the 14 inch screen and if you are on the go a lot, 4G LTE now available so would allow connectivity outside wi-fi coverage. Here is a link to answer your questions. https://chrome.google.com/webstore/...gjlekmpjp?utm_source=chrome-app-launcherAnd this app runs off line too.
jimmie
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Jon, I just realized I did not answer how easy it is to hook up to another monitor, so this link describes the process. When I mirrored to the TV the other day it was quite easy. https://support.google.com/chromebook/answer/1060909?hl=enHowever, I am not sure if you can hook up two monitors, but you can hook up one additional monitor. Roger, I should add corrections to how I answered your questions, I am not sure about your #2, I do not know for sure. And the chromebook lacks the processing power of a laptop. I defer to the tech gurus on your questions.
jimmie
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I need a laptop for my office for my staff to input information [and not being locked to a desktop.] So as I explore options, let me ask this:
1-Does the 'remote desktop' chromebook use a dedicated user account on a pc ?
2- Can multiple users be signed onto different chromebook units [can you run concurrent sessions from a single pc?
or, maybe I should ask, does a chromebook replace a Laptop running MS Remote Desktop Connection ? There are two different ways to use the Chromebook being described and they are both straightforward to implement. One is the Chrome remote desktop that is singular, the other is using a RDC client Chrome App like 2X that uses a standard RDC session. The second is in use in several of our client locations as a inexpensive portal tool for taking patient vitals, etc.
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Thanks all for your input.
Roger
Working Hard for the children in the community.
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Jon, I was able to convince Lisa to take a trip to Costco, it is a 90 mile drive one way and has to be one of the most beautiful interstate drives in the lower 48 between Great Falls and Helena. For about 20 dollars got 2-6 foot HDMI cables, one wall mount for 69 dollars, and a 22 inch Samsung screen/TV for 169 dollars. Plugged in the one HDMI cable to the 14 inch HP Pavillion Chromebook to the TV and was able to actually get 2 separate screens quite easily and have included a you tube video that explains how to. So I definitely have a "man crosh" for this intriguing device. Very easy to do and will be incorporating this in the exam room and if successful will replicate in my other exam room. If not will bring it home for personal use, either way will be fully utilized. http://chromespot.com/2013/11/18/chromebook-dual-monitors-glowing-indicator/
jimmie
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Jimmie has also demonstrated that he does video conferences with his ChromeBook. But I'll let him regale us with the latest of his Chrome crosh achievements.
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I got really desperate and put a shout out to Indy!!! No, seriously Indy on short notice was able to meet with my partners and I over a Hangouts call with the Chromebook. It was a very effective way to have Indy introduce himself and his services to the group and a very meaningful back and forth discussion ensued which I think was productive for all parties involved. The video stream and audio was quite adequate for this type of encounter.
jimmie
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.... and I didn't have to pay a co-pay since it wasn't actually an office visit. I was required to wear my hat though.
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Indy, I may have forgotten to mention we were using Helpouts with the Google Hangout so your co-pay bill will be arriving shortly!!!! http://venturebeat.com/2013/11/20/g...ut-video-consultations-with-your-doctor/We may consider your hat in lieu of wages. I changed the above link from the original I posted, as this one is more informative and does not have the live feed identifying those who view the link, which I did not realize when I originally posted.
jimmie
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On the double screen issue, my experience is a bit different than with the you tube video above and may have to do with difference in Chromebooks, but I am not sure.
But the method that works is if I open two tabs on the screen of my chromebook and at the very top of either tab just left of the little x I place my cursor and hold down the left click button at the same time move with my touch pad the entire tabbed page to the next screen. I can then work on the AC user board and stream in Netflix on the 22 inch TV screen while I work.
Also, as robtweed suggested in his article above, I think 2 step authentication is a must. I had not heard of this but implemented this extra precautionary measure, so that if anyone else obtains my password to my gmail account, he will also have to have my phone and get the 6 digit # texted to my phone when he signs on with the password. Unlikely to occur without my help, so lessens the risk of unauthorized users of my gmail/chrome account. Using the chromebook in the office changes how I use my gmail on other devices, I will use the chrome browser on other computers not mine, but will not sign to gmail unless either on my chromebook or my office computer. I also disabled my gmail account on my phone. These are just steps of extra security I am taking personally, probably just being paranoid, but.....
jimmie
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I just tried the Acer 11 inch Chromebook, that use to be mine, now the kids', and just a minor modification to get the dual screen function. It has an HDMI port as well so, hooking the HDMI/HDMI cable up to TV and chromebook, then going to menu on TV and select HDMI selection. Since the acer does not have the right and left click bar at the base like the HP Pavillion, you have to depress the touch pad on the side closest to you or its base with your left thumb, while you have the cursor on the tab just left of the x, and then while keeping the base of touchpad depressed, use your right index finger to drag tabbed page to the TV screen by pulling right.
jimmie
internal medicine
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I lost my 22 inch Samsung TV to one of my exam rooms today. It took about an hour and a half to find a stud, mount the TV holder, and get the TV leveled and attached correctly. But for about 260 for those parts and 279 for the chromebook have a nice setup to mirror AC on the 22 incher while in exam room. It may be technology overload for some folks, but will give update in the next week or two. I am a bit reluctant to use chromecast, and chose to use HDMI cable for now. Dr Mel showed me how to stream the Prevnar video on to the 22 incher, so will find out uses for this setup as time goes.
So thought I would try something different on the big screen TV at home, got the HDMI cable hooked to chromebook, and opened up 3 different tabbed screens on TV. On TV, Listening to Billy Bragg streaming on Pandora, Fox news, and AC and on chromebook, have CNN and netflix streaming.
Not sure why one would need so many tabs opened up at once, but it can easily be done.
jimmie
internal medicine
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Jim, thanks for keeping us updated on your trip down the Chromebrick Highway.
I am considering using Chromebooks (or a Chromebox, if there still is such a thing) as a client for our office staff in our our peer-to-peer network (hence my question about using two monitors, which would be one for AC and one for Updox, as we do with PC's). Any thoughts on this?
Jon
GI
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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!!!
jimmie
internal medicine
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Alright, on my list to answer, but I have to ask, Jim - when do you ever sleep?
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Our 1000 dollar spayed "free" barn cat, likes to scratch our leather couch or play the piano at about 3- 4am every night.
jimmie
internal medicine
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@Jimmie, What are you doing with a piano and leather couch in your barn? Sounds a little kinky to me 
Leslie
Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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@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.
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I love it!!!!!! Leslie is onto my hillbilly heritage/ways.
jimmie
internal medicine
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Jim may be manic, but we sure learn a lot from him. Keep it coming! 
Donna
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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.
jimmie
internal medicine
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Ah, yes, the things we do for out cats!
Donna
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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.
jimmie
internal medicine
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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?
jimmie
internal medicine
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jimmie
internal medicine
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![[Linked Image from ]](/ub/attachments/usergals/2014/01/full-3415-594-top_half.jpg) ![[Linked Image from ]](/ub/attachments/usergals/2014/01/full-3415-595-bottom_half.jpg) 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.
jimmie
internal medicine
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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.
jimmie
internal medicine
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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
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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.
jimmie
internal medicine
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...
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 ....
jimmie
internal medicine
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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.
jimmie
internal medicine
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Donna
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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.
jimmie
internal medicine
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Indy,
It is negative 33 with a windchill of negative 45. The solid state drive works in this weather.
My cat doesn't though...
jimmie
internal medicine
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Oh no, Jimmie....has he stopped playing the piano?
Leslie
Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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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.
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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???
jimmie
internal medicine
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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
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Jimmie, you should post a video of it in action!
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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
internal medicine
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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
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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.
jimmie
internal medicine
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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.
jimmie
internal medicine
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![[Linked Image from ]](/ub/attachments/usergals/2014/02/full-3415-600-20140213_091259.jpg) ![[Linked Image from ]](/ub/attachments/usergals/2014/02/full-3415-601-20140213_092406_1.jpg) 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.
jimmie
internal medicine
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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.
jimmie
internal medicine
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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.
jimmie
internal medicine
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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.
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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.
jimmie
internal medicine
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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.
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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.
jimmie
internal medicine
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Once you go Bi do you go Quad????
Yep love dual screen even though takes up more desk space.
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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. 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.
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But my son wanted to tell you, you are welcome and you have a "really cool" website. smile 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.
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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. Would using DisplayFusion take care of this situation? This is a subtle issue that is nagging, but it occurs with every edit, use of address book, electronic signature or use of the patient portal with Updox. I have to jump back and forth between screens. This issue is a nuisance, not unlike having the Dragon Bar on the top of the screen, needing to be minimized with every encounter and having to move the AC box down to complete the task. JBS solved that issue for me, and I cannot believe how not having to do an extra few clicks with every encounter improves my disposition! I am of the opinion, these extra steps, if identified and negated may lead to nirvana.
jimmie
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That's exactly what DisplayFusion does. Initially people would use the software to have a different wallpaper on each screen, but it gradually evolved into what it is now. I promised JBS a video on it as well. I must upload it soon.
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Sandeep,
That will be great. And is that the free or paid version?
jimmie
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The paid version gives you the multi-monitor task bars.
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I cannot believe how not having to do an extra few clicks with every encounter improves my disposition! Ah, a kindred spirit. I am of the opinion, these extra steps, if identified and negated may lead to nirvana. "In the Buddhist tradition, nirvana is described as the extinguishing of the fires that cause suffering." But that was before needless clicks were invented.
Jon
GI
Baltimore
Reduce needless clicks!
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Jon, To keep with the Chromebook theme I was thinking of nirvana in the Google dictionary sense---"a state of perfect happiness; an ideal or idyllic place." Now for something completely different...... One of my long time friends and confidante, who also happens to be from that other part of society, an ambulance chasing lawyer, had an interesting perspective regarding the duplicated larger chart projected in the exam room. Engaging the patient in the process of viewing and developing his own chart, and then documenting this at the end of the note, is extremely beneficial and protective from a medical legal perspective. I have not been documenting this at the end of the note, but not a bad idea.
jimmie
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Sandeep,
My daughter and I made some short videos today regarding my office set up with the chromebook, and plan to share these at the upcoming San Diego event, and if well received, may post these at a later time. If not, may have to redo the videos or think of other ways to get the message out.
jimmie
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http://www.medscape.com/viewarticle/821584?src=wnl_edit_specol&uac=176037MVAt the recent MMA (Montana Medical Association) leadership conference here in town, this idea of medical scribe was discussed. I agree with Art, in this piece on Medscape. I suggested to the MMA audience the use of technology, such as the Chromebook attached to a large screen TV, engages the patient, and in my opinion is much more cost effective than a scribe, and improves the patient doctor relationship in this technological age in which we find ourselves. I think the patients appreciate the opportunity to view, mold, and create their own chart, and benefit from the projected data lines of BP's, BMI's, Weights, Lipids, and HgA1C's. I have found the patient doctor trust enhanced and the mystery of the EHR deflated with this type of scenario. So before adding yet another staff member with a need for retirement and health insurance, think of some way to engage the patient with the EHR with the technological gadgetry currently available. IMHO, this set up not only maintains but accentuates the patient doctor relationship in the exam room.
jimmie
internal medicine
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I had difficulty with the chrome remote desktop application today. On my Chromebook, I was unable to center the open window by one finger scroll horizontally or vertically. This feature has been a time saver, so now have to put cursor over top of open window, left click and drag, instead of using the one finger scroll to center the open windows.
This inconvenience has forced to me to have a back up plan and one I should have been using, the VNC viewer for Google Chrome that uses the intranet and will be used only on local network. So will try it out tomorrow, but my initial toying around with the VNC viewer this evening has me wondering why I had not done this sooner.
So, will likely save the chrome remote desktop for out of office remoting, and VNC viewer for in office remoting.
I have reported this issue on the Google chrome OS line to see if there is a fix to this problem.
jimmie
internal medicine
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Chrome Remote Desktop, after the last update, will no longer work with multiple monitors. This is extremely inconvenient, and I hope gets fixed soon.
However,the VNC viewer, supports my dual monitor, and yesterday was extremely impressed with the functionality.
I was able to display on the right screen images of the CT demonstrating pneumonia, and on the left screen, display the type written report from AC, and slide back and forth with ease to display to patient and spouse on the 24 inch TV monitor.
This was received with such appreciation and so easily done, that I am planning to just make this a routine part of the visit, displaying the images from radiology studies for those patients interested. Something I have not been doing.
I also had another patient comment on the TV screen being matte and poorly reflective. With his business he is using dual monitor screens, but just bought TV's that do not have a matte finish but reflect window and lights more so. He said he wished he had gotten the matte finish for the screens. Something I had not thought of but lucked into.
jimmie
internal medicine
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Jimmie, are you timing the visits to see if this is now taking longer and, therefore, affecting your productivity?
Doctor Mel
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Doctor Mel,
No, just working out the "bugs". I have been really impressed with Chrome Remote desktop (CRD), until the multiple monitor support went south. I can switch to single monitor display on my desktop, but then the screen on my Chromebook is too small to be efficient with AC and Updox opened at the same time. I have to maximize and minimize windows too many times.
The VNC viewer I think is a bit snappier, and works better with Citrix/Meditech for radiology imaging projection on the large TV screen than the CRD. I have it only on the local network for now, but for the paid version, then I will be able to remote over the internet securely. The scroll between screens horizontally and vertically is faster than CRD, so am trying to get use to this change. One thing I like a bit better on the CRD is the ability to tab out and get onto the internet with another tab on the Chromebook and then tab right back into the CRD window. With VNC I have to close the app to get to the internet.
The 2x RDP client, I think, does not support multiple monitors, but will have to research this a bit.
So, I think I will likely do the VNC viewer 30 day trial for the ability to use both intranet and internet features with encryption, while travelling to the south this week.
However,to be efficient with the Chromebook in the exam room, IMHO, you have to have at least dual monitor support with your remote app.
I think I am noticing improved patient satisfaction, easier intake/data entry with new patients, less stress with add ons, and saving trees with less printing to paper, with the TV display/chromebook/dual monitor remote support in exam room.
jimmie
internal medicine
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I need to make a couple of corrections about VNC viewer. It is easy to minimize the screen and tab onto the internet without closing the application, The first 30 days the trial allows the Enterprise, Personal features, which allows encrypted internet features. The personal is 30 dollars one time fee and yearly cost for support is 1/4 the 30 dollar fee. And the enterprise is 50 dollars and support 1/4 that fee. Both intranet and internet dual monitor support work exceptionally well. This will replace the chrome remote desktop for me.
jimmie
internal medicine
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Jimmie: If I wanted to implement a display screen in the exam room, where should I go from here? I am already using a laptop - would I plug in a large TV screen with HDMI? What kind of interface are you using and can it be wireless?
Chris
Living the Dream in Alaska
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This may or may not work with your laptop.
On your desktop, right click desktop, click on screen resolution, extend displays, click apply, and then keep changes for the dual screen monitor function.
I use wireless on the chromebook, and use the intranet function behind the firewall with the local network in the office, for the remote desktop application-- VNC viewer.
HDMI to HDMI cable 10 foot x 2 with an inter connector if you need more than 10 feet--I got at costco
At least a 24 inch TV with 1080 resolution with a matte screen. I got this at costco.
Wall mount moveable arm.
Get your remote desktop working and you are in business. Just do some research to see what remote desktop works best with your OS on your desktop and laptop--
I recommend at least dual monitor capacity on your desktop to translate that to project xrays on your TV in exam room--sliding back and forth between screens is much easier on a small laptop in exam room, and displays easier. If Indy has time I will demonstrate this feature on a video at San Diego if there is enough interest.
Chris, this is why Amazing Charts is really leaps and bounds above any other EHR, to be able to display so nicely in the exam room. It is not only intuitive for the doc to use, but the patient can makes sense of their medical information quite easily.
jimmie
internal medicine
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Are you able to access Google cloud printers via 2x? I'm having difficulty seeing the printers I've enabled for Google Cloud, when logging into AC (Cloud based version) via 2x (using Chromebook). Any thoughts appreciated!
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SartellPeds, I am not using AC cloud based version or 2x remote desktop for chrome. So I am not quite sure. If I understand you correctly you want to print using your chromebook remoted into your desktop running AC in the cloud. Are you using any local desktops on your local network behind the firewall (intranet) to run on site printers in your office? If so, the you should be able to hook them up going to this site... https://support.google.com/cloudprint/answer/1686197?hl=enFor any PHI I use only the local printers behind the firewall (intranet). For teaching materials and non PHI I will print on my local printers using Google Cloud on occasion if I am not remoted into my desktop with VNC viewer (intranet) option.
jimmie
internal medicine
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Yes, that is exactly what we are trying to do. I am able to print using Google Cloud Printers on everything except when I remote into our cloud-based version of AC using 2X. From there, I am unable to see any of the printers I've enabled for cloud print. However, this kind of makes sense...just wondering if there's a way to do it or a work-around.
Using Windows-based RDC, I can choose to include printers as a 'local resource' available once the connection is established. From what I can tell this isn't available with 2X & Chrome...
Appreciate your thoughts!
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I had an event happen yesterday during a pre-op exam that is worth mentioning. I was doing my thing and going through the Past Medical History with a patient. And she wanted a copy of just the Past Medical history, and I told her I did not know of a way to do that. With the projected screen she walked me through how to do this by clicking on the file button in upper left corner of the Past Medical history screen when the letters are expanded and print to exam room printer. This reminded me recently when both Marty PA and Wendell were showing me of fascinating ways to use the F keys. I suppose to a certain extent I have been in a vacuum, so it is quite nice to learn new ways of doing things, but having the capacity to learn from patients on the projected AC chart was not one I ever anticipated, but will take any day of the week.
jimmie
internal medicine
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If I have one more patient tell me, "I want you to take this the right way, but this is the first time I feel like I have had a real exam."
I think I am on the right track with this and hope others can develop a way to have a projected screen with AC in the exam room.
But capturing the moment and engaging the patient with this humble set up has been very therapeutic.
There is something non-tangible but very much appreciated by patients who have been part of this new process, but I think getting them involved in the "record keeping" and "data interpretation" helps with the "buy in" of suggested treatment options.
jimmie
internal medicine
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A special thanks to John Squire, Charlie, Trish, and Heath in helping out with this video.
https://www.dropbox.com/s/bdjafgkkedgkkly/Dr%20Jim%20Legan%20%281280%20x%20720%29.mp4
jimmie
internal medicine
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One aspect I do not point out in the video, but what is really nice while traveling or from home, my desktop is replicated, usually with Updox on the right and AC on the left, so working off site on the Chromebook works quite well with the VNC viewer internet feature, instead of the intranet connection used at the office.
So handling faxes, messaging to and fro with patients, sending letters to patients works exceptionally well with the dual screen capacity.
jimmie
internal medicine
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John Howland, M.D.
Family doc, Massachusetts
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Thanks John.
It may be a bit easier to see the video by clicking on the You Tube icon on the Amazing Chart site, rather than right clicking and copying and pasting the above link.
I should have demonstrated printing with my VNC viewer remote driving my desktop, with my exam room printer(intranet) versus using Google cloud printing outside once disengaged from the VNC viewer (internet).
jimmie
internal medicine
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John (Howland),
I have not jumped into the AC cloud yet, but this thought is rattling around in my head, and thinking a similar system for an AC cloud user should work just fine.
One of the biggest criticisms of the Chromebook is lack of processing power and inability to print effectively.
However, if your main office computer is synced to your AC data base in the cloud. And you routed your printers through this microsoft based computer with the processing power, so that each of your exam rooms and office has a printer.
I think the idea of a desktop in every exam room, really becomes quite redundant. Why not take your "desktop" (chromebook with VNC viewer)with you into every exam room outfitted with a large flat screen TV and printer.
The biggest weakness of the Chromebook, small exam rooms, and being a bit on the frugal side, has led to this scenario in my own office except my AC data base is in my office computer and not in cloud.
This set up, including 3 printers, one chromebook, 2 TV's, cost me about the same as my HP laptop just 2 and a half years ago.
So, I not only have a very nice intranet based system in office that mimics my dual screen desktop, but anywhere I go, I can function as if I am in my office.
I was recently out of the office for 3 working days, and did not call my nurse one time. With Updox on my right and AC on my left screen, I could sign scripts, send lab results with letters, sign off mammos and paps, edit 02 orders, message nurse, in essence do everything to keep the office going using the internet feature of VNC viewer to duplicate my desktop.
So through the frailty of an outdated small office, a device without processing or printing power, the solution has worked much better than I ever anticipated.
So effective, I would replicate my current setup in a heartbeat, just as I have it, with the caveat of possibly transitioning to the cloud at some point, maybe....
I am drumming this incessantly with the hope of some young docs coming out of residency hearing my cry from the wilderness... the tools are there and very affordable and much more user friendly (I suspect) than the ones utilized in the ivory towers of residency.
And maybe nudging some not so young docs to try out, but John, I thought of you and just wondered with being outfitted with AC in the cloud if some portion of this solution may work for you, if you have such a need.
Not only are the tools affordable but what they afford you in the exam room or out of office is quite impressive.
jimmie
internal medicine
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I think this link works better than the above link I posted to see the video. https://www.youtube.com/watch?v=Dudm0-K9UE4
jimmie
internal medicine
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I hope to get another video out soon comparing the Google cloud print feature and how I print using the Chromebook in the exam room.
Two of the weaknesses of the Chromebook, not having much processing power or internal storage, I think is one of its greatest assets when used as a thin client (using it to remote drive my office computer). I do not have any patient information on the Chromebook, so when I take it out of office or home, there is less security risk.
Using the Chromebook as a thin client with the VNC viewer intranet feature at the office, allows me to use my office computer's processing power and storage. So when I have the Chromebook in the exam room, it appears to the patient that the Chromebook is running the printer. I cannot tell any difference in time printing in exam room with the Chromebook remotely running my desktop versus printing from my desktop to local printer.
However, on the video there is a noticeable difference in time printing using the Google cloud print feature, which is quite sluggish at times.
I realize the Chromebook is not for every one, and out of all my partners only 1/8 adoption rate.
However, whether one uses local in office storage or cloud storage, I think the Chromebook if used as a thin client attached to a local computer for processing power to run the printers and access the data base is a very useful tool.
If you add the HDMI port projecting to large TV screen feature and internet VNC feature to have your "desktop at home" one has a really versatile 279 dollar device.
jimmie
internal medicine
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I cannot let the statement about only 1/8 partners adopting the Chromebook pass, without a comment, since I am one of the partners. Years ago, before ever using an electronic medical record, I had a lap top in each of my exam rooms so that I could show patients educational videos from DVDs or from the web. When I instituted Amazing Charts about 2-1/2 years ago, I incorporated all-in-one large screen desktops in each of my exam rooms, so that I could show my patients their blood pressure and weight graphs, growth curves, x-rays, CTs, etc. Because my desktops are hard wired to a server and each has a dedicated printer in the exam room, I do not have to spend time plugging and unplugging a laptop into the system, risk dropping it etc. I did incorporate Jimmie's idea of a separate HDTV for easier reviewing of data, by the patient. This set up is much more expensive than what has been outlined by Jimmie, with use of the Chrome book set up, but has worked very efficiently, with minimal headaches, for the most part. I agree that, if one is operating on a shoestring, the Chrome book idea is a good one. I am of the opinion, however, that it is worth spending the extra money to have workstations and a server.
Doctor Mel
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Our office structure is such that since we are a limited liability partnership we have a creative milieu in which we can individually tailor our practices how we see fit. It has worked quite well over the years, so we can learn by trial and error and share our failures and successes quite succinctly with one another. The adoption rate comment was just that, an observation, and not a criticism. The one partner who has incorporated the Chromebook does not even use AC.
However, I think the system I have gravitated towards is a bit different compared to the workstation server model Doctor Mel uses. I would argue it is more than just a cost issue for me, but an avenue of exploration of trying to enhance my efficiency with a durable, easily replaceable device for point of contact with the patient. The unintended consequence has been the large screen "interactive TV" phenomena, that I am having fun with learning to do things differently each day depending on the needs of the patient.
jimmie
internal medicine
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I would like to add a couple of additional thoughts. I am not sure what the mean time between failure is of the HDMI port of the Chromebook, but one consideration is to buy one of these devices to reduce wear and tear. I may just get one and keep it plugged into the HDMI port of the Chromebook so this will take on the wear and tear instead. I still think avoiding the Chromecast dongle is the way to go to avoid leaving a chart up on the TV monitor when leaving the exam room. http://www.amazon.com/Monoprice-8in...eywords=hdmi+female+to+hdmi+male+adapterAlso, I got hand holding from my local IT guy for setting up the VNC viewer but here is the link. https://www.realvnc.com/products/chrome/1.0/connectguide/connect4.htmlI may have to do a bit more research to find the best HDMI to HDMI gadget, to save wear and tear. Also I ended up getting the Enterprise version of VNC viewer for chrome so I can maximize encryption to 256 bit.
jimmie
internal medicine
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The issue has been raised about the frequent inserting and pulling out of the HDMI cord on the Chromebook causing software issues.
The way I have it set up in my exam room, I think reduces the likelihood of an electrostatic discharge. The TV is plugged in and often times is off, as it turns off automatically after several minutes. The Chromebook is powered by the battery, and I do have the Chromebook on when I hook up the HDMI cable into the Chromebook.
I think the wear and tear issue is potentially more problematic, and will be getting the HDMI extender (as indicated above) so will hope to have some feedback on this issue more in the future. But a 5 dollar extender is easier to replace than an HDMI port in the Chromebook.
I think the unknown is how often or problematic the potential(?)software issue on the Chromebook or TV will present itself, if ever.
However, I have no patient data on either device (Chromebook or TV), so both are quite cheap and easily replaceable, so minimal downtime if a problem develops.
I think it is a manageable risk at this point, otherwise powering off the Chromebook at each coupling would be impractical.
I maintain the advantage of projecting AC on the large screen TV in the exam room, far exceeds the risk. I am knocking on wood, but nearly 4 months into this set up and no issues yet.
jimmie
internal medicine
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There is an additional dimension of this whole process that I am glimpsing and is becoming more apparent as time goes and at the risk of discussing while my ability to convey is somewhat in the gestational stage, I think, should be addressed.
The office visit, chart, desktop, Chromebook and TV terminology is rigid and what I am experiencing is malleable, expansive and fluid, and transcends these constructs.
The opened AC chart flows between the dual monitored desktop, Chromebook, and TV, and in fluid motion is not unlike a back and forth conversation or a balanced dance, that invigorates both patient and physician. I have been at this for 21 years, and I have never been able to replicate this effect with paper charting or the laptop/office desktop scenario.
I will have to do some more observing and whittling on my thought process but the office visit, with the portal takes on a similar dimension, where the office visit goes beyond the actual physical office space but includes the portal access to the patient's smart phone several days before and after the visit.
The same goes for the paradigm shift in how the office flow now occurs with secure messaging surpassing phone traffic, and messaging directly to my nurse bypassing the front office phone. I have taken on more traditional nurse roles, such as med reconciliation, and handling the prescriptions, but this allows her more time to schedule, shuffle paperwork, to do away with the traditional secretarial role.
But this malleable, fluid, expansive change of the AC chart has to be the most dramatic of all the changes I have noted since starting all of this in 2011.
I think my anger from 2011 when I felt I had no choice but to go electronic to avoid the penalties is being assuaged by these unexpected but pleasant developments in the office thanks to folks smarter than I coming up with all of these great tools. The trick is figuring out how to get the tools puzzled together to maximize one's work flow.
jimmie
internal medicine
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First day with the HDMI extender. I think it will take a bit of getting use to having the 8 inch cord dangling when walking back and forth from office to exam room, but I think certainly will work. The connection of the extender into the Chromebook HDMI port fits snugly and stays put quite nicely. I attached the 8 inch HDMI extender first thing this a.m. and left it in place and removed from the Chromebook after my last patient of the day. So just one in and out exchange will certainly save some wear and tear on the HDMI port of the Chromebook and want to give a shout out to Stephan on the twitter feed, who got me thinking in this direction.
Once I place the Chromebook on my computer stand in my exam room, it is easier to attach the end of the HDMI cord from the TV to the 8 inch extender. There is more room to work with and I can hold the extender in left hand and TV HDMI cord in right to make an easy connection.
jimmie
internal medicine
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What is your thought in regards to buying another Chromebook and leaving one in each room, turning them on and off as necessary, rather than carrying one Chromebook back and forth? I would think that it would be as easy to turn the Chromebook on and off as to repeatedly plugging it in and then unplugging it. A review of the way in which you connect to the main computer via the Chromebook would be of interest.
Doctor Mel
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I timed the following:
turn on chromebook --7 seconds
sign on chromebook --7 seconds
sign on to VNC viewer for chrome--25 seconds
sign off VNC viewer for chrome--8 seconds
turn off chromebook--6 seconds
unhook or hook HDMI extender to TV HDMI cord--1-2 seconds
It would be less efficient to have a chromebook in every exam room and turn on and off and sign on and off to VNC viewer in my opinion.
I plug in my chromebook and turn it on first thing when I arrive to office. When I am ready to see the first patient I sign onto VNC viewer for Chrome using the intranet connection, so that if internet connection is lost, I can still drive my main computer. My nurse sends me the chart, on my office desktop I open the patients chart and have the graph of weights up on screen. I then unplug my Chromebook and carry into exam room and set on computer table, plug in the HDMI extender end to the TV HDMI end, turn on the TV and the patients chart is ready to go with weights visible on big screen TV. After I finish with patient, I unplug the HDMI extender from HDMI TV cable, and carry the Chromebook back to office (TV screen goes black). I then set my Chromebook back on my office desk and plug in, and use Dragon to finish my note to complete the HPI and summary section, the ROS and EXAM I template out. Sign off the chart and print up my super bill and send the office summary to Updox inbox and my nurse sends to patient portal.
When lunch hour arrives, I sign out of VNC viewer and sign back in when ready to start seeing patients after lunch. At end of day I sign off VNC viewer.
This works extremely well. I very much like having two operating systems to balance my workflow, any internet searches I exclusively use the linnux OS on the Chromebook, and use my Microsoft OS for HIPAA dependent patient care (office desktop or VNC viewer for Chrome replicating desktop) except for when I search Up to Date embedded in AC when printing up patient information while in exam room.
Sorry so long winded, but hope this helps.
jimmie
internal medicine
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Here is a recent ChromeBook2 review that also covers the other shipping versions. The biggest take-away is that the latest Samsung ChromeBook2 now has a full 1920-1080 13" display and almsot 9 hour batter y life. http://www.engadget.com/2014/05/30/samsung-chromebook-2-review/
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![[Linked Image from amazingcharts.com]](http://amazingcharts.com/ub/attachments/usergals/2014/06/full-3415-657-20140606_120340.jpg) Here is a picture of the HDMI extender I keep attached to the Chromebook to reduce wear and tear on the Chromebook HDMI port.
jimmie
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For those interested I did make a few more videos about the Chromebook/TV/EHR approach. One can either click on you tube icon on AC website or click on the following link. https://www.youtube.com/user/AmazingChartsI am quite new to you tube, so please take that into consideration when watching.
jimmie
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"If the one who is to act wants to judge himself by the result, he will never begin." Soren Kierkegaard from Fear and Trembling.
I want to thank all of you for bearing with my intensity and help on this Chromebook thread, but I think I have stumbled into a system that works extremely well for my workflow. I think that this set up or a modification there of, with at least a large screen linked to a device that controls the main data base and is managed by the doc really works.
I think we are extremely lucky to have the Amazing Charts EHR to project the health information to the patient. What I do not know is how other EHR's project, but I think AC can be a prototype to other EHR designers, as I think over the next several years this will be the push for "patient engagement".
I do not think I am leading anyone down the wrong pathway here, but will be interested in feedback if others do try this set up to let me know how it works out.
I think I will be moving from the chromebook theme to explore the social media arena a bit more and will add new insights on the chromebook from time to time.
jimmie
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Jimmie,
I am impressed that you were able to use Updox (which I have not tried yet) and VNC viewer/chromebook to operate your desktop computer remotely while out of town. I may have to try the chromebook/vnc viewer for just that feature alone. Like you I am not on the Amazing Charts cloud.
Greg
Greg Mosolf
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I have been using the VNC viewer made for Chrome Enterprise version so I can use msximum encryption and dual monitor function.
When I was away from the office a while back, I could message my nurse within AC, edit forms, e-sign scripts and send labs and function as if I was on my desktop, except on the Chromebook of course. I do not use dragon on the chrome but type, so have not explored that avenue.
I really think the Chromebook if used properly can transform how you access your office remotely and point of contact with patient in office with the #ProjectedEHR feature.
Thanks Greg!
jimmie
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jimmie
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Greg,
One additional thought I had, is if you take the vnc viewer/chromebook/updox plunge, would you consider a 10 dollar HDMI cord and flat screen TV?
I would be extremely interested in feedback to see how projecting all of the vaccinations to ma, pa and child would be at office visit.
I have a feeling it would be similar to some of my medicare patients with twice as many herbals than prescription meds, and sorting out the complex med list. Which has been tremendously improved with projecting on the large TV screen, and working through together.
I know with my own kids, seeing this at the visit on a shared screen manipulated by the doc to edit, correct and then print up would be helpful.
Thanks again for your feedback, as it is immensely helpful.
jimmie
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I would like to thank Gabriel Perna for doing a fantastic job on this!!! I also want to thank everyone on this user board for all the great help and insight. Never in my wildest dreams did I think a 169 dollar TV and a 279 dollar chromebook remoted into my data base would or even could impact patients in such a powerful way. I have been invited to talk in Chicago in October at the user conference on this subject. If any one else has implemented part or some of this approach, I would be interested in some feedback. For those interested Rob Tweed has some great articles regarding the Chromebook from his perspective on my twitter site or his which are fascinating. http://www.healthcare-informatics.com/article/montana-one-physician-brings-ehr-bigger-screen
jimmie
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I am interested in any feedback from the ACUC in Chicago. Anyone try the Chromebook TV yet. My most recent blog on my twitter site came about by preparing for this conference. http://jimmievanagon.wordpress.com/...ome-visual-and-educational-at-the-visit/I think the design of Amazing Charts lends itself well to projecting visually. Not unlike the walls of a gothic cathedral reverberating with the sound of an a cappella boys choir. I think if the simple to use and understand EHR like AC is intertwined with a simple affordable visual conduit like #ProjectedEHR, the ability to teach is magnified.
jimmie
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I cannot believe it has been nearly two years since starting the #ProjectedEHR approach, as I call it on twitter, where I continue to meet great folks from all over the world. I haven't been as active on the ACUB of late due to energies being focused elsewhere, including delving a bit into the Periscope & Blab realm. I wanted to share my wordpress link to share some of the videos on #ProjectedEHR & also links to periscope/katch and Blab, some paintings & blogs thrown in unfortunately. https://jimmievanagon.wordpress.com/about/If any of you are interested in blabbing sometime, it is a great way to meet & next best thing to meeting IRL. ?I hear and I forget. I see and I remember. I do and I understand.? Confucius Have a Happy New Year all !
jimmie
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jimmie
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Here is a quote from the above mentioned article. "Doctors also might turn the computer screen so that the patient can see it as well, Frankel said. That way, the computer could become a tool that helps a physician educate their patient on their own health status. Patients looking over a doctor's shoulder also might be able to catch any errors or typos in their health record." And here is a Periscope video I did a while back to demonstrate my particular set up, and of course, "there is more than one way to skin a cat" (modified Mark Twain quote). https://www.youtube.com/watch?v=kz9rVtRpuI0Many thanks to JBS, Indy, Sandeep, & many others that have helped along the way down this Chromebook Highway !
jimmie
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Excellent! I do something similar with all-in-one 27 in inch computers and just angle them so the patient can see.
Kevin Miller, MD
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Kevin, Thank you very much for your response, and if you care to answer I am very interested in how often you do this and what your patients think when you do. This has become a bit of a passion for me and I think started when I went from the paper chart world at the end of 2011. At the time I was interested in making the transition to capture the MU $ and avoid the MU penalties when my motherboard went out on my then brand new laptop I just started using at the point of care in each exam room. I found myself running between my desktop office computer and the exam rooms learning quickly when I had to refer to the computer. It was a very frustrating and painful transition but I learned a lot, especially when I wish I had the laptop to point something out or refer to. Your feedback is much appreciated.
jimmie
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jimmie
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Going to resurrect this old thread, but the trackpad went out on my HP 14 inch Chromebook so just got the ACER 14 inch chromebook and have been using for a week. Here is a review: http://www.androidcentral.com/acer-chromebook-14-reviewIt is by far the best chromebook I have used to date. A good deal for the price IMHO. So if you are looking for a chromebook, this one may be worth taking a peek.
jimmie
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Do these run Windows? AC says for v9 you need a minimum of an Intel i3 processor. Do you thinks this will run v9?
Chris
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Chris, The chromebook I am using, the 14 inch Acer, no, but runs on Chrome OS. Here is a link about it. http://www.computerworld.com/article/2893364/is-chrome-os-right-for-you.htmlHowever, I use the chromebook at the point of care, as my simulated dual monitored desktop that has windows 7 with a beefed up processor. I use the Enterprise version of VNC view made for chrome to turn my chromebook into my "desktop". Here is a link on VNC viewer made for chrome. https://www.realvnc.com/products/chrome/With the HDMI port of the chromebook use an HDMI cord hooked to a wall mounted TV screen, 24 inch to share the EHR experience with the patient in real time. Works slick. I have not tried this but windows can be installed on a chromebook. Here is a link. http://www.digitaltrends.com/computing/how-to-install-windows-chromebook/Thanks Chris.
jimmie
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Do these run Windows? AC says for v9 you need a minimum of an Intel i3 processor. Do you thinks this will run v9? Chris, Most of our clients use the Chromebook RDC app to connect to an AC server via terminal services; be that their local server or our managed environment. This makes the Chromebook superior to a laptop in many respects. We have a client looking at the Chromebook Pixel as a high-end replacement that travels with them like a tablet. If the Doc needs assistance in buying or implementing AC or the accompanying infrastructure, let us know.
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Chris, I am on version 9.1 and on AC in the cloud and the VNC viewer made for chrome Enterprise Version with 256 bit encryption, behind the firewall on the intranet works very well. However, more than one way to skin a cat, so I have not used the RDP for chrome, but using RDP with my main desktop to "attach" to AC in the cloud. What I like about the VNC viewer is that it is easy to toggle between the "simulated desk top environment" and the native Chrome OS to go out onto the internet. And the VNC viewer supports the dual monitor function, which comes in handy such as looking at xray images on the right screen and AC on the left, to show pts on the wall mount TV, or toggling and googling stuff together too. I blame Indy for pushing me down the chromebook highway by the way, my life has never been the same LOL .
jimmie
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Jimmie,
Hello, I have just read through all of this forum as I am trying to go mobile in my office. I was originally looking at the surface pro but stumbled on the chromebook and then this forum. It sounds like at some time you made the transition from in office server to cloud based AC which is what we use currently. The IT helpdesk recommended hard wired devices if using an app to log into a desk top in office. I'm assuming you are using a wireless system with the chromebook? If so do you have any issues with connectivity when you are "attaching," to AC in the cloud? Are you aware of anyone doing the same with an apple product? I currently use a MacBook to log in to my desktop when away through GoToMyPC and it seems to work fine, was wondering if there is an advantage to the chromebook vs a mac for in office use like this?
Sounds like you have been through quite a journey with all of this. Thank you for any insight you can provide.
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Jimmie,
Hello, I have just read through all of this forum as I am trying to go mobile in my office. I was originally looking at the surface pro but stumbled on the chromebook and then this forum. It sounds like at some time you made the transition from in office server to cloud based AC which is what we use currently. The IT helpdesk recommended hard wired devices if using an app to log into a desk top in office. I'm assuming you are using a wireless system with the chromebook? If so do you have any issues with connectivity when you are "attaching," to AC in the cloud? Are you aware of anyone doing the same with an apple product? I currently use a MacBook to log in to my desktop when away through GoToMyPC and it seems to work fine, was wondering if there is an advantage to the chromebook vs a mac for in office use like this?
Sounds like you have been through quite a journey with all of this. Thank you for any insight you can provide. You have several options. For our clients who run in our managed environment, or on AC's you can use RDC to connect directly. In some cases, we have had to request that AC provision RDC versus just the App. With RDC, you can use both Chromebooks and Macs. If AC is unable, unwilling to help, just give me a shout. It just takes some attention to detail. There are a host of reasons to move away from Microsoft centrics solutions. Mobile solutions and improvements are moving quickly.
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Atlasdoc, What Indy describes is a bit different than what I use at the office. For home I use a microsoft os base HP EliteBook laptop to directly connect via RDP to the cloud AC. AC tech support got all that hooked up for me. Also access updox from the laptop at home--works great can do everything I can here at office at home, except see pts, and now that I am e-scribing scheduled meds, works well, when I take time off from office. However what I do from the office is a bit different. I have a standing dual monitored desktop (as my nurse) both RDP directly to cloud AC & both with updox--so only have 2 computers to maintain/upgrade in my "pod". What I do with the chromebook is connect to my office desktop behind the firewall (intranet) with VNC viewer made for Chrome, Enterprise Version with 256 bit encryption for security. We upgraded our Instant Access Point with Aruba 110 series. I can't even remember the last time I had a dropped connection with this wireless set up. However I am not transferring records or using the RDP function but just remote controlling my desktop with the chromebook, and can use two screens with the swipe on my touchpad. The chromebook is easy to replace, with two step authentication, takes less than 5 minutes when you change out to a new one by signing into your gmail account and entering the 6 digit # to complete the 2 step authentication, so minimizes downtime with the point of care device in the office. Hope this makes sense and helps, let me know if you have any other questions.
jimmie
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Jimmie, thanks for the info. Couple follow up questions.
Is there a reason that you don't just use your laptop at that office with direct access vs remote access with the chrome?
I remote in to the office with a macbook Air from home through gotomypc, is there a benefit to using chromebook vs the mac for this purpose? Do you know of anyone using a VNC viewer with a Mac in their office?
Forgive my tech ignorance, You said that you access AC directly from home but through an RDC? I thought using an RDC implied that you were remotely accessing a desktop or server?
Thanks again for your help.
M. Heim, DO
Solo FP/Anti-Aging Medicine
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Thanks Indy! will reach out if I can't figure things out. Probably after 10 hours of stubbornly trying to figure it out on my own.
M. Heim, DO
Solo FP/Anti-Aging Medicine
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M. Heim,
I use to use the laptop I now use at home at the office. I don't use it much except on Fridays when I take off over the summer, or once in awhile on the weekends (at home). It takes about 2-3 minutes to power on, quite a bit heavier, clumsier than the chromebook. When I use the VNC viewer on the chromebook, it is easy to click out and use the native linux os to go out onto internet and google with patients. And then click right back into my simulated desktop with AC on the chromebook. But most importantly about 1/4 the cost of the laptop and easily replaceable, and dummy proof, no upgrades or antivirus--so cheaper to maintain than the laptop--ie. don't worry about upgrading to windows 10.
Maybe Indy or Sandeep can answer your second question, I am not an apple fan, overpriced in my opinion,so I don't know. For what I need the laptop for at point of care the chromebook can do everything I need and in some respects better because of the solid state drive, noise free and fast on & off. Plus the battery on the chromebook can out last the laptop by two fold, up to 12 hours according to some of the reviews I have seen. Cost is the main reason I choose a chromebook over a macbook.
Your third question also may be better answered by Indy or Sandeep but my understanding is that VNC viewer remote controls the desktop whereas RDC is like the actual desktop imaged on the device you are using. So I wanted to differentiate using RDP from home on laptop versus VNC viewer from office with chromebook.
Also, one can port in through the firewall and I could connect to the office desktop with the chromebook from home with the VNC viewer for chrome too, but don't because I already had the laptop, and since I don't use it much don't mind using that as my device of choice from home, but could easily use my chromebook too.
One of my partners did use GoToMyPc with an I-pad but now uses the HP-stream as device at point of care with GoToMyPC, she likes having the keyboard on the stream.
jimmie
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Thanks again Jimmie,
I am trying the mac today as I already own it and figure it is a good trial. Using it with gotomypc. So far so good. Will likely go to the chrome book for my MA to room patients for cost purposes.
M. Heim, DO
Solo FP/Anti-Aging Medicine
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.... You said that you access AC directly from home but through an RDC? I thought using an RDC implied that you were remotely accessing a desktop or server? To connect directly to an AC instance (describing our connection capabilities), there are three approaches: RDC, RemoteApp, or secure HTML. Most clients use their Windows/Mac/Linux/Chrome device and use RDC. Those are all direct connections.
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M.Heim, You bet ! If you decide on a chromebook, I have found the 14 inch matte screen works best, I tried the 11 inch screen and too small for my 50+ year old eyes. I have been very pleased with the 14 inch acer, now about 3 weeks of use. One trick I discovered is to hit control + or control- to enlarge or minimize for ease of reading or viewing. Also & this may be pushing my luck here, if you have a 24 inch screen TV or larger, hook up an HDMI cord between the two and use the mirroring capacity of the chromebook to share what you are doing at point of care. If you do let me know how it goes and thanks again for your questions and conversation. Thanks Indy for your thoughts too
jimmie
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Dell has a micro form factor desktop that is small enough to attach behind the monitor, running an Intel i5. One of them has the capacity for 3 displays and HDMI and Display Port connectivity. I'm thinking about this for the exam room with a second screen for the patient. I'd like to get rid of paper entirely, but I'm still printing lab sheet for patient review.
Chris
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Chris, If you decide to do this, let us know how this works for you.
jimmie
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So far, I'm very happy with the small form factor from Dell. It must be built with laptop components, because there is no big fan and it uses a transformer like a laptop does. It's one of our fastest computers now, as well as being tiny. It's nice to have the reception desk cleared off of the bulky tower case.
Chris
Living the Dream in Alaska
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Just playing around with my new 15.6" touchscreen Acer Chromebook I just got today. I really like the back lit keyboard, the touch screen and largest screen I have ever used with a Chromebook. We will see how it performs in the office next week but I think I am most interested in how much I will use the touch screen. I have been thinking about making this change for a while, and finally decided today since Walmart had a pretty sweet deal. Maybe more on this topic later. There is no HDMI port but I had to get a usb-c to HDMI adapter, which should work just fine. Battery life is suppose to be more than 12 hours according the reviews I read.
jimmie
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I have been very pleased with the new 15.6" Acer today, I have been using it as my simulated desktop in each exam room with VNC Viewer made for chrome all day without a recharge and still have 6:18 left on the battery. I will be installing RDP for chrome so I can now turn the chromebook into my new laptop (will replace my old HP notebook laptop), so I will be able to use AC in the Cloud and Updox and do my secure video chat and work from home or vacation. Or if i lose internet and or electricity at the office, I can then use my mifi device from verizon and keep working on the chromebook. So for an affordable price this will be an excellent solution for the present and future, it will be my point of care device simulating my desktop with VNC viewer, or my new "laptop" RDP'd into AC in the cloud. I am disappointed with Medical One Dragon, claiming to be a cloud based solution, but unable to be deployed from a chromebook with the dragon extension for chrome. I do hope they get with the times to get this option available in the near future, or other solutions will push them from the market place IMHO.
Also the touch screen does not work when I use VNC viewer to simulate my desktop. This is the nicest laptop I have ever used. Takes seconds to turn on and off too.
jimmie
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Hi Jim,
I am in the market for a Chromebook, but I want a smaller, light one, for travel.
You have a lot of experience with them, any recommendation?
Donna
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I like the Acer's but I have only tried HP's otherwise. Minimum screen size I would recommend would be 14 inches, I found this link that might help you make a better decision. https://www.t3.com/features/best-chromebook
jimmie
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Thanks, Jim! I'll look at the Acers.
Donna
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You bet Donna !!!! I was just thinking of our trip out to Laramie when you saw the big old moose at Vedauwoo, fun time that trip was. And if you can get a back lit keyboard, I would recommend that for sure. I love this 15.6 " ACER I have now.
jimmie
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Yes, Jim, that was a great trip! That is still the only time I have seen moose, even though I go to Maine every year. I really miss the ?old days? of AC with the original owner, the physician centric focus, and wonderful colleagues all working together to learn the new technology. Those were fun times.
I went to Walmart today to see the Chromebooks. The 15.6 looks really nice and it?s a great price. But, I think it is a little bigger than I want for travel. And you?re right, smaller than 14 is too small. They did not have the 14 inch on display, so I want to see if I can find it to demo before buying.
Donna
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My current traveling ChromeBook is a Acer CB3 431.
14", aluminum, light, tight, and outta sight! (retro reference there)
Very tough, and a serious improvement over my previous ones.
Got it at Costco on sale for ~ $200 iirc.
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Thanks, Indy! It just so happens that the Acer you have is the one I honed in on today.
Ha, ha, I recognize your retro reference.
Donna
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I found another use for the Chromebook-RDP connection inadvertently today. Near the end of the day I just started running my antivirus scan on my desktop, and after I signed out of AC on my desktop my nurse asked if I would do 5 more things on AC. I panicked for a second, thinking I would have to either wait for the scan to get done, or finish things up at home. Then I realized I could just sign in on my chromebook rdp to AC in the cloud, keep my desktop antivirus scan going and get the stuff done. So yet another nice feature of the rdp chromebook feature.
I also realized I have 15 gb of data with a mobile hotspot on my phone, so easy to connect to the chromebook, and with the improved battery life on my phone, this will be a very viable solution to keep working in my office if i lose internet and or electricity. Of course my nurse won't be able to work on her desktop but we can at least keep working, where as before having the rdp chromebook connection I would be at a standstill and unable to work.
jimmie
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