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Blogging IT One Word at a Time

By Bill Elmore ·
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Weighing the benefits of electronic medical records

by marciaesp In reply to Weighing the benefits of ...

<p>I have been an RN since 1957, worked in many hospital settings, including a physician's office. Medical records have <strong>never been totally secure</strong>! I am also an <span>amateur</span> computer person, got my first Commodore 64 in 1983, on my 12th computer now. I believe computerized medical records are definately the way to go! The pros out weight the cons so very much in my opinion. In our immediate family alone we have had ancillary hospital personal divulge sensitive, confidential medical information to others three times, all done without the need of a computer! </p>
<p>Marcia</p>

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Weighing the benefits of electronic medical records

by vbock In reply to Weighing the benefits of ...

<p><em>This is a no-brainer.</em></p>
<p>Would that it were so, in the short term.  Until there's a standard for the EMR data record, the risk of choosing wrong is extremely high for any given player. My husband is a solo practitioner, being squeezed by higher malpractice premiums and lower insurance reimbursements, and we're having to invest thousands of dollars this year in upgraded computers and software because the feds have come up with a new data structure for EDI (Electronic Data Interchange) to handle the billing side.</p>
<p>It's very clear to me that EMR is the future, but we can't afford to invest in a system only to find out that the hospitals, or the docs he shares coverage with, or Medicare, or Blue Cross standardize on something else.</p>

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Weighing the benefits of electronic medical records

by vbock In reply to Weighing the benefits of ...

<p><em>This is a no-brainer.</em></p>
<p>Would that it were so, in the short term.  Until there's a standard for the EMR data record, the risk of choosing wrong is extremely high for any given player. My husband is a solo practitioner, being squeezed by higher malpractice premiums and lower insurance reimbursements, and we're having to invest thousands of dollars this year in upgraded computers and software because the feds have come up with a new data structure for EDI (Electronic Data Interchange) to handle the billing side.</p>
<p>It's very clear to me that EMR is the future, but we can't afford to invest in a system only to find out that the hospitals, or the docs he shares coverage with, or Medicare, or Blue Cross standardize on something else.</p>

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Older and wiser, but still struggling with the concept of sharing

by Bill Elmore In reply to Blogging IT One Word at a ...

<p class="MsoNormal">Well, I finally did it. 
Last week I finally allowed myself to let go of a support issue that I
didn?t need to continue supporting.  I?m
sure most techies would agree that sometimes it?s just tough to step away from
a task and let someone else handle it.  Who
better to fix something than you, right? 
You?re never fully confident someone will do as good a job as you would
do; it?s called human nature.  And at the
center of it all is a little thing called trust.</p>

<p class="MsoNormal"></p>

<p class="MsoNormal">Who better to fix the interface server with the transactions
backing up?  Who can get that SQL Server
cluster back up the quickest when it loses connection to the SAN?  Outbound email isn?t being sent.  Who better to fix that?  The answer, of course, to all of these
questions is the person staring back at you in the mirror ? YOU.  </p>

<p class="MsoNormal"></p>

<p class="MsoNormal">But then again, if you?re always busy saving the world each
day, who is installing the new systems and upgrades?  Who is performing health checks on your
directory services infrastructure and mail servers?  Who is reviewing system logs and keeping up
to speed on all the latest <a href="http://www.microsoft.com/technet/security/current.aspx">security patches</a> released by Microsoft this month?  If the answer is still you, you may have a
problem; if not now, then soon.</p>

<p class="MsoNormal"></p>

<p class="MsoNormal">At some point, we have to transition a new system or upgrade
from the installation and ?baby sitting? phase to the general support and
maintenance phase.  The ?anyone on my
team should be able to troubleshoot this? phase.  That is, of course, assuming you posted build
notes and support documentation for each of your installed systems.  You did do that, right?</p>

<p class="MsoNormal"></p>

<p class="MsoNormal">Yeah, I thought so, me too. 
Who has time to take screen shots and document support procedures for a
system that is newly installed and, at the moment, stable?  It is agonizingly time consuming and boring ?
not nearly as interesting as saving the world from certain peril.  We generally exist in the workplace to rush
around and extinguish fires and high-five our successes.  There isn?t much glory in pasting Print
Screens in a Word document and creating a Table of Contents with
hyperlinks.  But if you don?t do it
relatively soon after a new installation, you may later find yourself
scratching your head and sifting through notebook pages and emails to figure
out what to include in the documentation. 
And what?s worse, until it?s complete, you will be the one person
supporting the system.</p>

<p class="MsoNormal"></p>

<p class="MsoNormal">That?s pretty much the scenario I often find myself.  I work a few months or longer to get a new
system in place, and then, as soon as it?s complete and stable, I move on to
the next project.  Documentation is an
afterthought.  But sooner rather than
later the system will hit a bump, and I will get the privilege of fixing it
because I didn?t bother to share support information.  Some of this is because I was too lazy to
document, and some is because sometimes it?s just quicker if I fix it myself.</p>

<p class="MsoNormal"></p>

<p class="MsoNormal">Or at least it seems to be quicker.  In reality, it?s more costly to the end users
and me.  I end up with too many irons in
the fire so to speak.  I get stretched
too thin and find myself unable to respond to support issues in a timely
manner.  Think about it.  Implement several new systems each year at
multiple sites, multiply that times a few bygone years, and you quickly find
yourself unable to juggle adequate support alone.</p>

<p class="MsoNormal"></p>

<p class="MsoNormal">The solution is to trust your colleagues, empower them
through communication and adequate support documentation, and realize that it?s
not a good thing to hold a monopoly on all the systems you?ve been given
responsibility for.  It?s easy to believe
that by holding onto knowledge that no one else has, you are more valuable to
your company.  But in reality your job
performance suffers and you become a liability. 
It?s okay to let go.  Really.</p>

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Older and wiser, but still struggling with the concept of sharing

by cssatx In reply to Older and wiser, but stil ...

<p>The same phenomena happens with managers, although with different outcomes. Most managers got to where they are by having demonstrated some degree of expertise. As a manager you need to allow your team to do what they do best. If you continue to be involved in firefighting and the minutia of the work, how can you become an effective manager. Again, the solution is to trust that those you manage can get the job done ... at least as good as you would do it.</p>

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Older and wiser, but still struggling with the concept of sharing

by propellerheadus In reply to Older and wiser, but stil ...

<p>I find that most people would rather die than think for themselves, and take responsibility.  I write documentation.  I do knowledge transfer on tools (share point, live meeting, office suite documents, etc).  And I find that in my particular areas of expertise that I'm still the best one to do certain tasks no matter how much I try to transfer the knowledge.  </p>
<p>Perhaps I'm a poor communicator, but I try hard to do exactly as you suggest.  I find that folks give up and pass it to me, as opposed to me going and seeking the tasks out.</p>

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Older and wiser, but still struggling with the concept of sharing

by th7711 In reply to Older and wiser, but stil ...

Agree with Bill and sharing the view from klking@.... Someone is just too lazy to pick up new knowledge or skill. This kind of people should not stay in the field as they have no IT professionalism.  

<p>To resolve this issue, I suggest to define the accountability of each individual member in your team clearly and shift the duty among them. If you have a team less than 3, don?t bother. You don?t have this luxury as you are in the fire-fighting situation everyday.</p>

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Older and wiser, but still struggling with the concept of sharing

by The Old Man In reply to Older and wiser, but stil ...

<p>Klking brings up a great point.  There hopefully will always be something we are the best at,, but 10 (give or take) years ago someone in the background who was the best let us fumble through it, make the mistakes that always teach us the most, and empowered us to become the ?best?.</p>

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Death by printing and political maladies

by Bill Elmore In reply to Blogging IT One Word at a ...

<p class="MsoNormal">Here?s a dilemma that?s frustrated many an IT pro for
years. If we truly are in the electronic
age and everything is becoming digitized, why, oh why, are we spending so much
time troubleshooting and accommodating printing issues? Printing is the bane of our existence, always
rearing its ugly head when we least expect it.
We can customize the interfaces of a new system to work with existing
applications and deftly coordinate a multi-site client rollout to appear
seamless to the user, but it?s troubleshooting the printing problems that drive
us absolutely bananas!</p>


<p class="MsoNormal">Users seem to print more now than ever. Replace a paper system with an electronic
system and what happens? Users print reports
and screen dumps. Most of what?s printed
out is thrown right into the trashcan. A
quick search on the internet reveals that numerous <a href="http://www.treecycle.com/pissues.html">organizations</a> and educational <a href="http://www.udel.edu/topics/printless/how.html">institutions</a> report a
sustained gradual increase in paper usage.
That can be an entirely separate topic for another day, but my point is
electronic systems aren?t decreasing the amount of printing by users, they?re
increasing it. And as it increases, the
more importance is placed on the printing infrastructure and the more IT staffs
walk around with headaches from chasing down the myriad of resulting issues.</p>


<p class="MsoNormal">To compound the problem, the cost of printers continues to
go down while the quality of lower end printers continues to rise. So it?s becoming increasingly easier for
staff to justify purchasing personal printers.
Everyone can create a reason for why they ?need? a printer of their very
own. Mostly, managers play the
confidentiality card. They can?t be
expected to print performance reviews and other confidential documents on the
departmental printer. Okay, fine. I can
accept that. Plunk a printer down in
their office. But then staff reports
that they need printers for the mobile laptop carts. Reason ? they can?t walk down the hall to the
unit?s main printer. That would negate
the benefit of having the mobile cart in the first place. Then the billing department reports that they
require individual printers to print each customer?s account screen. Reason ?
it?s easier to read the printouts than the screen. </p>


<p class="MsoNormal">See where this is going?
It?s a runaway train headed down a steep cliff. It appears we?ve spoiled our users into
expecting technology coddling. Think of
someone at home frantically looking for the TV remote instead of walking over
and turning the channel (I?m not saying I?ve never done it.) <i>I?ve
got to have it now and I shouldn?t have to move to get it.</i></p>


<p class="MsoNormal">So what is wrong with so many printers scattered around the
workplace? It complicates the printing
infrastructure and can severely hinder the deployment of thin client based
solutions. The more printers installed
in an environment, the greater number of model types, and that means there are
a greater variety of print drivers. It
becomes impossible to keep up with the number of drivers needed on Citrix and
Windows Terminal Servers; keeping up with the model type, platform and whether
it?s PCL 4, 5e, 6 or PostScript (please, anything but PCL 6.) </p>


<p class="MsoNormal">Printing in thin client environments has improved in recent
years. There are better universal
drivers from companies like HP and Citrix; better but not perfect. And special features such as duplexing are
usually forfeited when using a universal versus model specific driver. Citrix MetaFrame Presentation Server 4.0 has
an improved printing architecture, but still has its challenges. Unless you can keep up with print driver
mappings and experimenting with which driver type works for different
applications, you will always have a fair share of printing issues to
troubleshoot. </p>


<p class="MsoNormal">For example, a user with an attached scanner connects to a
Citrix server and the session hangs because the server can?t correctly map a
driver for the scanner. All subsequent
client sessions stall keeping anyone else from accessing the published
application, and the print spooler service hangs, not stops, preventing print
jobs from successfully printing. For a
solution, you can ferret out individual printers and add mappings each time, or
choose to only connect a client?s default printer, or even install a local
printer on the server and disable client printer connections altogether. But troubleshooting printing issues will
continue to consume a better part of your time.</p>


<p class="MsoNormal">Sure, you can attempt to standardize on the printers being
deployed and drivers used. But models
get phased out and replaced, and drivers get updated by users with proper
rights or local IS staff, etc. It?s not
quite as easy to maintain as one would imagine, especially in large
corporations. Depending on the company
you work for, chances are good that IT doesn?t have the political clout needed
to keep certain departments and users at bay when attempting to
standardize. There may be times when you
can?t tell someone ?no? to having a personal printer or ?no? to certain brands
and models. </p>


<p class="MsoNormal">So what is the solution?
I don?t exactly know. Maybe you
can tell me. IT isn?t generally a
revenue generating department so our influence sometimes falls short compared
to a department that is a company cash cow.
Sound off and let me know your experiences!</p>

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Death by printing and political maladies

by pjcasey75 In reply to Death by printing and pol ...

As a consulting dealing with electronic forms solutions, having also been a printer rep calling on Fortune 100 companies in the past, I can confirm that the electronic revolution, especially web based systems, has increased, not decreased, the amount of printing in the world.  Standardization is a dream mostly unfulfilled.  And, as you noted, the reasons for failing to implement solutions which are already available (centralized printing/scanning/copying/faxing on high capacity departmental multifunction devices or utilizing advanced networked print management tools) are mainly political, not technical.  Lastly, you hit the nail on the head when you mentioned that clout is related to money.<br /><br />So here's how to find some clout.  You have to frame the argument for change in terms of money.  And then you have to go to someone, usually outside IT itself, like the VP of Sales or the CFO, even the CEO, someone with clout, who's looking for money.  Money to hire people, money to run an ad campaign, money to open a new office, or maybe money to keep from having to lay off precious resources.<br /><br />No one in your company, and I mean no one, has their arms around how much money the company is literally throwing in the trash can.  Try asking purchasing how much money is spent on paper and toner.  Lots of times they can't really tell you, or if they can, they're missing pieces of the data.  Facilities buys paper and toner for copiers, departments and units buy "office supplies".  This waste is hidden in thousand thimballs all ovrer the place, and no one knows the big picture.  No one budgeted the company's overall cost of printing.  Purchasing may actually buy it all, but who uses the supplies, and for what purpose?  What's the overall budget?  And how far over or under budget (yeah, right) are you?<br /><br />Until someone internally (outside vendors can give you numbers or do surveys, and because they're vendors, no one will believe them) does a study and proposes a solution WITH NUMBERS, no one will have the impetus for change.  Whining about how much trouble printers are for IT to handle doesn't work either.  Most of the time the attitude is - I want a printer, and it's your job to make it work.  You have to put a cost on it, and go high in the organization to someone who's concerned about that cost.<br /><br />For IT, troubleshooting printers "consume(s) the better part of your time".  Most people outside IT don't realize how much time you really spend on this.  They think you're doing "cool stuff".  Count the cost of that time and let the company know what else you'd like to do with the time you're planning on saving with your new efficient printer strategy.  Printing is like toilet paper - everyone needs it, everyone expects it, and everyone complains if you don't have it right here, right now, but no one wants to talk about it.   It's not the "cool stuff", but if it consumes the better part of your time, overspending time an money on it needs fixing.  Lastly, if you do decide to tackle this analysis, don't put your most junior IT person on the task just because no one else wants to deal with it.  That action too, reduces "clout" in the eyes of the company.<br /><br />PJ Casey, Consultant<br /><br />

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