One of my irritations

[The White Coat Investor]

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http://www.usatoday.com/news/military/2009-07-30-careaccess_N.htm

The number of Army medical centers and clinics that provide timely access to routine medical care has hit a five-year low, Army records show, often forcing soldiers and their families to seek treatment off base. About 16% of Army patients, particularly family members, can't get appointments with their primary physicians and are sent to doctors off the installation, according to the results of a nine-month Army review finished late last year. Some of those patients end up in emergency rooms or urgent care centers

Some? Some days it feels like they all end up in the ED.

At any rate, I get sick of apologizing to people for the inability of my hospital/medical system to get them an appointment with their doctor. When there aren't appointments they have to call each morning at 6 am to try to get one. I don't want to spend forever on hold to get an appointment, much less do it at 6 in the morning. Who would?

 

[backrow]

I was reading through the Tricare Access to Care standards the other day and surprisingly for primary care appointments the requirement is within 7 days.

I know some clinics are having success with "open booking"

 

[The White Coat Investor]

I was reading through the Tricare Access to Care standards the other day and surprisingly for primary care appointments the requirement is within 7 days.

I know some clinics are having success with "open booking"

Yes, but most successful private practices work very hard to keep their patients from going to urgent cares or emergency departments at all during the hours they're open. There's a lot of revenue in urgent visits (abscesses and lacs reimburse well for example.) They actually reserve same day appointments and people can actually get them without calling at 6 am.

 

[NavyFP]

Yes, but most successful private practices work very hard to keep their patients from going to urgent cares or emergency departments at all during the hours they're open. There's a lot of revenue in urgent visits (abscesses and lacs reimburse well for example.) They actually reserve same day appointments and people can actually get them without calling at 6 am.

Ahhhh, but we are not working on a revenue model. Another part of the primary care problem is that most civilian primary care practices will book 4 per hour with one work-in (total 5 patients per hour). Most military primary care clinics are 3 per hour (and heaven forbid you try to walk a patient in). Many providers would complain about Q15 appts because so many of our patients come in with a list of 10 issues they want to address per appointment. Part of that is that they know they will have extreme difficulty getting another appointment and they want to get it all done while they have you in front of them creating a vicious cycle.

Solutions are difficult and will be met with resistance.

 

[rotatores]

Many providers would complain about Q15 appts because so many of our patients come in with a list of 10 issues they want to address per appointment. Part of that is that they know they will have extreme difficulty getting another appointment and they want to get it all done while they have you in front of them creating a vicious cycle.

Very true!

 

[IgD]

Another part of the primary care problem is that most civilian primary care practices will book 4 per hour with one work-in (total 5 patients per hour). Most military primary care clinics are 3 per hour (and heaven forbid you try to walk a patient in)...

I think a big factor there is AHLTA and support staff. In military primary care you could be a lot more efficient with dictation and an adequate number and depth of support staff.

 

[Chonal Atresia]

Maybe if the military didn't pay their physicians like horsesh...t or make them type their notes they might actually be able to retain some people as well as recruit civilians. I actually saw an ad on a well-known locums website recruiting for an army ENT position at Ft. Gordon. The ad actually included as part of it's requirement being able to TYPE 60 WORDS A MINUTE! Not gonna get too many takers when the money is substantially less and you require doctors to type their notes. Just my two cents.

 

[IgD]

Maybe if the military didn't pay their physicians like horsesh...t or make them type their notes they might actually be able to retain some people as well as recruit civilians. I actually saw an ad on a well-known locums website recruiting for an army ENT position at Ft. Gordon. The ad actually included as part of it's requirement being able to TYPE 60 WORDS A MINUTE! Not gonna get too many takers when the money is substantially less and you require doctors to type their notes. Just my two cents.

One time I was at a meeting at a Navy MTF. The surgery residents were complaining that the operating room was inefficient. The Admiral and her O6 assistant were present. The Navy CAPT explained that it was to the MTFs benefit to be inefficient. He said the hospital had a fixed amount of money so the fewer patients they saw the more they could stretch the money between patients. I almost rolled out of my chair on that one...

 

[a1qwerty55]

One time I was at a meeting at a Navy MTF. The surgery residents were complaining that the operating room was inefficient. The Admiral and her O6 assistant were present. The Navy CAPT explained that it was to the MTFs benefit to be inefficient. He said the hospital had a fixed amount of money so the fewer patients they saw the more they could stretch the money between patients. I almost rolled out of my chair on that one...

The math is fairly different now. The military is moving towards paying hospitals to some degree in proportion to how much workload they generate. At one point there was an "efficiency wedge" where budgets were fixed and each hospital would complete for their piece of the fixed pie with other facilities (a bad idea in my opinion and eventually killed). An example of how RVU's matter, if I can show that a nurse practitioner or another doctor can increase RVU values in my clinic at a level equal to or greater than their salary, I can usually get the person hired. This really only applies however to clinics sending a lot of workload downtown or are procedure heavy, thus high rvu generating. I don't think anyone is sitting around saying less generate less RVU's (be less efficient in today's environment).

 

[Gastrapathy]

The math is fairly different now. The military is moving towards paying hospitals to some degree in proportion to how much workload they generate. At one point there was an "efficiency wedge" where budgets were fixed and each hospital would complete for their piece of the fixed pie with other facilities (a bad idea in my opinion and eventually killed). An example of how RVU's matter, if I can show that a nurse practitioner or another doctor can increase RVU values in my clinic at a level equal to or greater than their salary, I can usually get the person hired. This really only applies however to clinics sending a lot of workload downtown or are procedure heavy, thus high rvu generating. I don't think anyone is sitting around saying less generate less RVU's (be less efficient in today's environment).

The math may be different in a local sense. Do more work (or document more work) and get a bigger share of the pie. But the basic reality is that any part of the DoD budget spent on medical care isn't spent on something else. This is especially true with the over-65 population. We save money on every TFL pt who decides to get their care on the economy because medicare is their primary insurer and TFL is a secondary insurer.

So while no one is saying "generate fewer RVU's" at the local level, there will always be pressure to minimize access. If you ask me, this has been AF policy for about a decade and the other services may not be too far behind.

 

[dru2002]

Maybe if the military didn't pay their physicians like horsesh...t or make them type their notes they might actually be able to retain some people as well as recruit civilians. I actually saw an ad on a well-known locums website recruiting for an army ENT position at Ft. Gordon. The ad actually included as part of it's requirement being able to TYPE 60 WORDS A MINUTE! Not gonna get too many takers when the money is substantially less and you require doctors to type their notes. Just my two cents.

The military is just embracing the way of the future. Two of the hospitals in my town and my universities health service require the same thing. My bet is that within the next 15-20 years you would be hard-pressed to find hand written notes anymore. Haven't seen any studies but I would guess legible notes cut down on medical errors. I would also assume it facilitates digital health records which cut down on repeated procedures and also save money. Perhaps if CHCS didn't blow, it would be less of a headache.

 

[i want out]

The military is just embracing the way of the future. Two of the hospitals in my town and my universities health service require the same thing. My bet is that within the next 15-20 years you would be hard-pressed to find hand written notes anymore. Haven't seen any studies but I would guess legible notes cut down on medical errors. I would also assume it facilitates digital health records which cut down on repeated procedures and also save money. Perhaps if CHCS didn't blow, it would be less of a headache.

I don't think you will get much argument that EMR is the way everything is going, but I am unhappy about how we are getting there.

For day to day notes in the hospital, its easier to type them yourself. For longer things like procedure notes, and H&P's dictating it would be much easier and quicker for the physician. Quicker for the physician translates to efficiency, private sector at least cares a little about efficiency, because it translates to revenue. The .mil doesn't really care about efficiency, because they own you 24/7 and don't have to pay you any differently if you spend 8 hours at the hospital, or 12 because your typing your own notes. And since you can't vote with your feet until your contract is up, there is significant lag time between implementation of a flawed system, and system failure.

i want out(of IRR)

 

[dru2002]

I don't think you will get much argument that EMR is the way everything is going, but I am unhappy about how we are getting there.

For day to day notes in the hospital, its easier to type them yourself. For longer things like procedure notes, and H&P's dictating it would be much easier and quicker for the physician. Quicker for the physician translates to efficiency, private sector at least cares a little about efficiency, because it translates to revenue. The .mil doesn't really care about efficiency, because they own you 24/7 and don't have to pay you any differently if you spend 8 hours at the hospital, or 12 because your typing your own notes. And since you can't vote with your feet until your contract is up, there is significant lag time between implementation of a flawed system, and system failure.

i want out(of IRR)

Fair enough. I can definetly see your point.

 

[psychbender]

The military is just embracing the way of the future. Two of the hospitals in my town and my universities health service require the same thing. My bet is that within the next 15-20 years you would be hard-pressed to find hand written notes anymore. Haven't seen any studies but I would guess legible notes cut down on medical errors. I would also assume it facilitates digital health records which cut down on repeated procedures and also save money. Perhaps if CHCS didn't blow, it would be less of a headache.

I don't think he's complaining about typing his notes, vs handwriting them. I'm pretty sure he's complaining that he cannot dictate notes. I'm a fairly fast typer, and really hate dictations, so typing works fine for me, though I would prefer a much better EMR, as ours quite frankly suck.

 

[TopSecret]

Maybe if the military didn't pay their physicians like horsesh...t or make them type their notes they might actually be able to retain some people as well as recruit civilians. I actually saw an ad on a well-known locums website recruiting for an army ENT position at Ft. Gordon. The ad actually included as part of it's requirement being able to TYPE 60 WORDS A MINUTE! Not gonna get too many takers when the money is substantially less and you require doctors to type their notes. Just my two cents.

60 wpm? That's pretty fast.

Does anyone use Microsoft Word's or OpenOffice's AutoCorrect feature and templates to minimize the typing? Is it possible to copy and paste text from a word processor into AHLTA?

http://www.brighthub.com/computing/windows-platform/articles/19771.aspx

http://employment.families.com/blog/medical-transcription-using-autocorrect-while-transcribing

I use this technique quite a lot in practice. It saves time.

 

[orbitsurgMD]

60 wpm? That's pretty fast.

Does anyone use Microsoft Word's or OpenOffice's AutoCorrect feature and templates to minimize the typing? Is it possible to copy and paste text from a word processor into AHLTA?

http://www.brighthub.com/computing/windows-platform/articles/19771.aspx

http://employment.families.com/blog/medical-transcription-using-autocorrect-while-transcribing

I use this technique quite a lot in practice. It saves time.

The entirely missed point is that you hire a scribe to do the typing as you speak.

What an incredily inept personnel office to be requiring a physician to type at 60 WPM. That alone tells you enough about the climate of poor ancillary support, disregard for the value of physician time and managerial ineptitude at that Army facility. I am sure that "helpful" bit of information spared more than a few prospects the wasted time of an email, let alone an interview.

 

[AF M4]

The entirely missed point is that you hire a scribe to do the typing as you speak.

What an incredily inept personnel office to be requiring a physician to type at 60 WPM. That alone tells you enough about the climate of poor ancillary support, disregard for the value of physician time and managerial ineptitude at that Army facility. I am sure that "helpful" bit of information spared more than a few prospects the wasted time of an email, let alone an interview.

Heh, yesterday I had a patient come in to my clinic after falling on the sidewalk and badly injuring her leg. Nice and swollen, she's in tears, can't put weight on it, etc., I want to do an X-ray.

So I send her down the hall to get the X-ray. Get a call back from rads five minutes later saying that the machine is down for the 3rd time in as many weeks and that the repair guy will come in later, maybe in the afternoon. At this point they're on a first name basis with the dude. You get the picture. Anyway, until then they're useless. Strike one.

So I can't do the X-ray. Fine, I'll send her to the ER where they have machines that work. Would like to give her some medication for the pain for the trip (her husband is driving). Then my CAC card dies. Call the computer techs, they're not picking up the phone. Walk upstairs to find the NCO sitting at his desk and (I swear to God I am not making this up) trying to get good at drawing farm animals while not looking at what he is doing. He has more than a dozen pictures of a horse on his desk. He is ignoring the ringing phone. I take his pen away from him and he repairs my certifications.

Return to my sobbing patient. I have one of my techs put a splint on her and ask for crutches. Unfortunately we are out of her size crutches. We will be for a long time, because we are no longer budgeted for this. We spent all our money on $500 executive chairs for the admin upstairs.

Our wheelchairs have gone missing to parts unknown.

So my patient's husband had to carry her out of the clinic and to the pharmancy to get the medications, then out the door and to the car, with me holding the doors for them along the way because I felt relieved to be able to do SOMETHING. Meanwhile my other patients are stacking up.

I was not able to do the note documenting this because AHLTA crashed later that afternoon. Another day of medicine in the USAF.

 

[TopSecret]

The entirely missed point is that you hire a scribe to do the typing as you speak.

What an incredily inept personnel office to be requiring a physician to type at 60 WPM. That alone tells you enough about the climate of poor ancillary support, disregard for the value of physician time and managerial ineptitude at that Army facility. I am sure that "helpful" bit of information spared more than a few prospects the wasted time of an email, let alone an interview.

It's like that at a lot of residency programs and fellowships where EMR is implemented. Dictating notes is a huge timesaver but transcription services may not be cost-effective if they charge more than 10 cents per line and are full of errors that you'll have to edit the notes on a computer anyway.

 

[TopSecret]

Heh, yesterday I had a patient come in to my clinic after falling on the sidewalk and badly injuring her leg. Nice and swollen, she's in tears, can't put weight on it, etc., I want to do an X-ray.

So I send her down the hall to get the X-ray. Get a call back from rads five minutes later saying that the machine is down for the 3rd time in as many weeks and that the repair guy will come in later, maybe in the afternoon. At this point they're on a first name basis with the dude. You get the picture. Anyway, until then they're useless. Strike one.

So I can't do the X-ray. Fine, I'll send her to the ER where they have machines that work. Would like to give her some medication for the pain for the trip (her husband is driving). Then my CAC card dies. Call the computer techs, they're not picking up the phone. Walk upstairs to find the NCO sitting at his desk and (I swear to God I am not making this up) trying to get good at drawing farm animals while not looking at what he is doing. He has more than a dozen pictures of a horse on his desk. He is ignoring the ringing phone. I take his pen away from him and he repairs my certifications.

Return to my sobbing patient. I have one of my techs put a splint on her and ask for crutches. Unfortunately we are out of her size crutches. We will be for a long time, because we are no longer budgeted for this. We spent all our money on $500 executive chairs for the admin upstairs.

Our wheelchairs have gone missing to parts unknown.

So my patient's husband had to carry her out of the clinic and to the pharmancy to get the medications, then out the door and to the car, with me holding the doors for them along the way because I felt relieved to be able to do SOMETHING. Meanwhile my other patients are stacking up.

I was not able to do the note documenting this because AHLTA crashed later that afternoon. Another day of medicine in the USAF.

Drawing farm animals? Was the NCO ordered to do this?

 

[a1qwerty55]

60 wpm? That's pretty fast.

Does anyone use Microsoft Word's or OpenOffice's AutoCorrect feature and templates to minimize the typing? Is it possible to copy and paste text from a word processor into AHLTA?

http://www.brighthub.com/computing/windows-platform/articles/19771.aspx

http://employment.families.com/blog/medical-transcription-using-autocorrect-while-transcribing

I use this technique quite a lot in practice. It saves time.

My colleagues and I dictate all our notes with Dragon 10 medical. Very fast, very few errors and the ability to paste in macros - examples being patient education, health maintenance checklists, routine procedures, exams etc.
The Army has committed to providing this to all military physicians as a central purchase.

I prefer this to a transcriptionist as using one is as you point out more expensive, and they make as many errors as dragon, and you have to go back and edit at a later date. I like having all my notes done by close of business.

 

[TopSecret]

My colleagues and I dictate all our notes with Dragon 10 medical. Very fast, very few errors and the ability to paste in macros - examples being patient education, health maintenance checklists, routine procedures, exams etc.
The Army has committed to providing this to all military physicians as a central purchase.

I prefer this to a transcriptionist as using one is as you point out more expensive, and they make as many errors as dragon, and you have to go back and edit at a later date. I like having all my notes done by close of business.

The earlier versions had some problems and so a lot of docs I know stuck with transcriptionists, some of them overseas and working for a fraction of the cost. The newer versions of Dragon require a pretty fast processor. I guess the military is up to date on their hardware.

 

[The White Coat Investor]

I guess the military is up to date on their hardware.

Ha ha, that's a good one.

I share my office (2 computers) with 17 nurses, 3 PAs and 11 doctors. You'd think we'd have pretty top notch computers huh. I can buy one ten times better from Dell for $200.

 

[TopSecret]

Ha ha, that's a good one.

I share my office (2 computers) with 17 nurses, 3 PAs and 11 doctors. You'd think we'd have pretty top notch computers huh. I can buy one ten times better from Dell for $200.

Two? Can docs buy their own computers and use them at the office?

 

[AF M4]

Two? Can docs buy their own computers and use them at the office?

Heads explode at the thought of us using jump drives on government computers. So no.

 

[TopSecret]

Heads explode at the thought of us using jump drives on government computers. So no.

What about complete workstations that you just leave at the office?

 

[AF M4]

What about complete workstations that you just leave at the office?

Huh, I've never heard anyone actually ask this question before. I imagine there would be a long stunned silence in the tech department as they thought of exactly how many security scanners they'd have to put on the computer. There's probably a rule against this somewhere, but no one would have any idea where it's actually located since I doubt that the issue of someone trying to bring in their own computer for permanent government office use comes up often. Probably want to avoid the impression that you'll toss cash around this much, else they'll have you buying your own office furniture, paper and printing toner as well.

 

[dru2002]

What about complete workstations that you just leave at the office?

We would occasionally plug in a personal laptop to the network and within an hour we would have a call from IT about the unauthorized computer on the network. The call was immediately followed by the internet being shutdown on the LAN outlet. This would be followed by a letter in the next couple of days about how only gov't computers could be connected to the network. I don't know if there is an appropriate channel to get approval for a pc but anecdotal evidence says it's an uphill battle.

 

[TopSecret]

Huh, I've never heard anyone actually ask this question before. I imagine there would be a long stunned silence in the tech department as they thought of exactly how many security scanners they'd have to put on the computer. There's probably a rule against this somewhere, but no one would have any idea where it's actually located since I doubt that the issue of someone trying to bring in their own computer for permanent government office use comes up often. Probably want to avoid the impression that you'll toss cash around this much, else they'll have you buying your own office furniture, paper and printing toner as well.

Good point about having to buy other stuff.

 

[Chonal Atresia]

The military is just embracing the way of the future. Two of the hospitals in my town and my universities health service require the same thing. My bet is that within the next 15-20 years you would be hard-pressed to find hand written notes anymore. Haven't seen any studies but I would guess legible notes cut down on medical errors. I would also assume it facilitates digital health records which cut down on repeated procedures and also save money. Perhaps if CHCS didn't blow, it would be less of a headache.

The wave of the future? Have you completely lost your mind? Having an EMR is a GOOD THING, typing your notes into the EMR system is NOT a good thing. I frequently moonlight at a hospital with both inpatient and outpatient EMR systems. No typing is done by the physician EXCEPT for amending mistakes in DICTATED notes sent to your mailbox for review and signing. Even though I have built custom spec and est templates into AHLTA, it still takes me on average 3-4 minutes to type a follow-up note and 6-7 minutes to type a new note. It takes me half this time to dictate (not a good use of 9 years of medical education).

I guess you could "bullet" your enitre AHLTA note (those of you in the military know exactly what I mean) and be faster, but these notes are completely WORTHLESS. I frequently run into these types of notes in which the provider contradicts themselves from one line to the next (i.e. "mass felt in the neck" and then next line "normal neck exam") because he/she is "clicking boxes" and not actually thinking and free-texting what he/she actually "saw." AHLTA breeds both confusing as well as poor documentation. I always feel embarassed when I refer patients out of the DoD system and send my AHLTA notes (even though I free text a majority of the note) with them as they certainly are not user-friendly.

4 years and 10 months, but who's counting? Thank god for moonlighting.

 

[TopSecret]

We would occasionally plug in a personal laptop to the network and within an hour we would have a call from IT about the unauthorized computer on the network. The call was immediately followed by the internet being shutdown on the LAN outlet. This would be followed by a letter in the next couple of days about how only gov't computers could be connected to the network. I don't know if there is an appropriate channel to get approval for a pc but anecdotal evidence says it's an uphill battle.

The uphill battle may be worth it if it means more time on a computer to review labs and complete notes and computers less likely to crash because of insufficient RAM or outdated components.

 

[dru2002]

The wave of the future? Have you completely lost your mind? Having an EMR is a GOOD THING, typing your notes into the EMR system is NOT a good thing. I frequently moonlight at a hospital with both inpatient and outpatient EMR systems. No typing is done by the physician EXCEPT for amending mistakes in DICTATED notes sent to your mailbox for review and signing. Even though I have built custom spec and est templates into AHLTA, it still takes me on average 3-4 minutes to type a follow-up note and 6-7 minutes to type a new note. It takes me half this time to dictate (not a good use of 9 years of medical education).

I guess you could "bullet" your enitre AHLTA note (those of you in the military know exactly what I mean) and be faster, but these notes are completely WORTHLESS. I frequently run into these types of notes in which the provider contradicts themselves from one line to the next (i.e. "mass felt in the neck" and then next line "normal neck exam") because he/she is "clicking boxes" and not actually thinking and free-texting what he/she actually "saw." AHLTA breeds both confusing as well as poor documentation. I always feel embarassed when I refer patients out of the DoD system and send my AHLTA notes (even though I free text a majority of the note) with them as they certainly are not user-friendly.

4 years and 10 months, but who's counting? Thank god for moonlighting.

I see your point. I suppose dictation is much faster. I thought you were comparing handwritten v. typed notes. I type faster than I handwrite so I didn't see the issue. Thanks for the correction.

 

[a1qwerty55]

Ha ha, that's a good one.

I share my office (2 computers) with 17 nurses, 3 PAs and 11 doctors. You'd think we'd have pretty top notch computers huh. I can buy one ten times better from Dell for $200.

Most computers have been replaced in the Army with tablets with at least 2MB or RAM. Speed has not been an issue. It is important to point out that Dragon 10 uses a totally different architecture than ealier versions and as such has much better accuracy. I've worked with 9.0 and then 10.0, the difference for me was pretty dramatic.

 

[a1qwerty55]

I guess you could "bullet" your enitre AHLTA note (those of you in the military know exactly what I mean) and be faster, but these notes are completely WORTHLESS. I frequently run into these types of notes in which the provider contradicts themselves from one line to the next (i.e. "mass felt in the neck" and then next line "normal neck exam") because he/she is "clicking boxes" and not actually thinking and free-texting what he/she actually "saw." AHLTA breeds both confusing as well as poor documentation. I always feel embarassed when I refer patients out of the DoD system and send my AHLTA notes (even though I free text a majority of the note) with them as they certainly are not user-friendly.

For the reasons you describe above I don't know anyone who uses the "MEDCIN tree" the +/- check boxes. It just creates an illegible, contradictory and dangerous note.

 

[a1qwerty55]

Two? Can docs buy their own computers and use them at the office?

The Army tablets would all you to take them home but I strongly feel work shouldn't be taken home.

 

[TopSecret]

The Army tablets would all you to take them home but I strongly feel work shouldn't be taken home.

Your office has tablets and others are left with 2 computers for 30+ providers?

How did your office get so lucky?

 

[IgD]

Your office has tablets and others are left with 2 computers for 30+ providers?

How did your office get so lucky?

The Army is the 900 lb gorilla. They get whatever they want even take from the other services. My friend said an Army base wanted to med evac a service member to her facility. It was funny because the Army had 8 psychiatrists while the Navy had 2. She laughed because the reality was she should be med evac'ing to the Army base!

 

[TopSecret]

The Army is the 900 lb gorilla. They get whatever they want even take from the other services. My friend said an Army base wanted to med evac a service member to her facility. It was funny because the Army had 8 psychiatrists while the Navy had 2. She laughed because the reality was she should be med evac'ing to the Army base!

Isn't the other poster in the Army, too?

The med evac might've occurred because the Navy docs weren't as busy despite the difference in numbers. Are Individual Augmentees still being used or has that practice died down?

 

[The White Coat Investor]

Most computers have been replaced in the Army with tablets with at least 2MB or RAM. Speed has not been an issue. It is important to point out that Dragon 10 uses a totally different architecture than ealier versions and as such has much better accuracy. I've worked with 9.0 and then 10.0, the difference for me was pretty dramatic.

I got curious so I actually checked the specs on the newest computer installed in our department. It isn't so bad, 2.3 ghz triple core processor, 3 MB of Ram, a 150 gig hard drive. I can't believe how slow it runs. There must be a bazillion programs running in the background. It certainly can't handle me using a spreadsheet, CHCS, outlook, and internet explorer all at once.

As far as why there are only 2 computers for 30 of us, keep in mind these are the office computers. There are actually 6 more in the department for use while actually seeing patients. One for each of three providers, two for the techs to put orders in, and one not hooked up to the network for nurses to print out discharge instructions on. But when you're doing any kind of admin or CBT work (or just want to check your email) you've got to fight for one of the two office computers. Crazy.

 

[TopSecret]

I got curious so I actually checked the specs on the newest computer installed in our department. It isn't so bad, 2.3 ghz triple core processor, 3 MB of Ram, a 150 gig hard drive. I can't believe how slow it runs. There must be a bazillion programs running in the background. It certainly can't handle me using a spreadsheet, CHCS, outlook, and internet explorer all at once.

As far as why there are only 2 computers for 30 of us, keep in mind these are the office computers. There are actually 6 more in the department for use while actually seeing patients. One for each of three providers, two for the techs to put orders in, and one not hooked up to the network for nurses to print out discharge instructions on. But when you're doing any kind of admin or CBT work (or just want to check your email) you've got to fight for one of the two office computers. Crazy.

You should run Task Manager (control alt delete) and see which apps are hogging the CPU.

 

[AF M4]

You should run Task Manager (control alt delete) and see which apps are hogging the CPU.

Just running AHLTA itself is a massive CPU hog. Worse, it consumes more and more memory and processing power the longer you let it run or the more patient charts you look at. Look at more than 20 patients in one sitting, do more than a dozen notes or stay logged in for a morning and you might as well reboot the computer since everything will move at a glacial pace until you do.

 

[TopSecret]

Just running AHLTA itself is a massive CPU hog. Worse, it consumes more and more memory and processing power the longer you let it run or the more patient charts you look at. Look at more than 20 patients in one sitting, do more than a dozen notes or stay logged in for a morning and you might as well reboot the computer since everything will move at a glacial pace until you do.

It sounds like it's not using RAM properly. The glacial pace is probably from the virtual memory being accessed. It could be that the more the computer uses the hard drive for memory (after using 100% of the physical RAM) the more security programs are activated to check for any viruses or malware being installed. So it just works extra hard because of improper use of RAM.

A fix might be to install more RAM like 8 GB or however much the computer could take.

 

[AF M4]

It sounds like it's not using RAM properly. The glacial pace is probably from the virtual memory being accessed. It could be that the more the computer uses the hard drive for memory (after using 100% of the physical RAM) the more security programs are activated to check for any viruses or malware being installed. So it just works extra hard because of improper use of RAM.

A fix might be to install more RAM like 8 GB or however much the computer could take.

Certainly a strong solution, and I would greatly appreciate someone with the proper expertise implementing it.

Remember though, my systems guy spends most of his day trying to draw farm animals with his eyes closed, and my computer gets flagged and blocked from the network by all the failsafes installed that go off if I try to mess with anything in the Control Panel window. I do not have a lot of faith that this issue will be fixed in my lifetime.

 

[Gastrapathy]

I had the computer guy tell me that my computer would be faster if I just used it for AHLTA and never ran anything else (not simultaneously...ever).

 

[a1qwerty55]

Ha ha, that's a good one.

I share my office (2 computers) with 17 nurses, 3 PAs and 11 doctors. You'd think we'd have pretty top notch computers huh. I can buy one ten times better from Dell for $200.

You are an AF GMO correct?

If so another example of how the AF has zero interest in supporting their physicians. Essentially every Army physician should have a personal tablet, even my residents each have one with wireless connectivity.

 

[TopSecret]

Certainly a strong solution, and I would greatly appreciate someone with the proper expertise implementing it.

Remember though, my systems guy spends most of his day trying to draw farm animals with his eyes closed, and my computer gets flagged and blocked from the network by all the failsafes installed that go off if I try to mess with anything in the Control Panel window. I do not have a lot of faith that this issue will be fixed in my lifetime.

How frustrating. Is there remote access for AHLTA so that you could review charts the night before or is that simply not possible?

 

[AF M4]

How frustrating. Is there remote access for AHLTA so that you could review charts the night before or is that simply not possible?

In theory there could be. One of the senior physicians on my base has been fighting for months to obtain access to AHLTA on his computer in the squadron that he supervises and where his office is located, so that he doesn't have to drive over to the medical group to help his flyers. Thus far he has been unsuccessful, and this is on base. Trying to obtain access at home would be a Herculean endeavor, the most applicable Labor for analogy being turning the course of a river in order to clean out a huge stable full of dung.

 

[TopSecret]

In theory there could be. One of the senior physicians on my base has been fighting for months to obtain access to AHLTA on his computer in the squadron that he supervises and where his office is located, so that he doesn't have to drive over to the medical group to help his flyers. Thus far he has been unsuccessful, and this is on base. Trying to obtain access at home would be a Herculean endeavor, the most applicable Labor for analogy being turning the course of a river in order to clean out a huge stable full of dung.

It seems like it's possible for the other services...

Are there any Navy docs who use AHLTA from home?

http://www.med.navy.mil/sites/nmcsd/Staff/Pages/RAANMCSDStaff.aspx

 

[backrow]

It seems like it's possible for the other services...

Are there any Navy docs who use AHLTA from home?

http://www.med.navy.mil/sites/nmcsd/Staff/Pages/RAANMCSDStaff.aspx

I used to be able to do it at NMC Portsmouth, was awesome. Could finish notes from home if I didn't feel like sitting at work.

The fact that I even needed to complete notes from home shows how slow the system is though...

 

[TopSecret]

I used to be able to do it at NMC Portsmouth, was awesome. Could finish notes from home if I didn't feel like sitting at work.

The fact that I even needed to complete notes from home shows how slow the system is though...

At least you have access. It would then be possible to review charts the night before and flag those that deserve extra attention the following day.

 

[a1qwerty55]

Your office has tablets and others are left with 2 computers for 30+ providers?

How did your office get so lucky?

I'm not in the AF. We do have home access for all out programs be it AHLTA, outlook, Essentris etc.