Medical Practices Simply Can’t Afford To Skimp On IT Infrastructure

1964, Dynamic control problem being studied in the Analogue Computer Laboratory

Analogue Computer Laboratory – 1964. Source.

The Earth orbits the Sun, and medical practices can’t afford to skimp on IT infrastructure… some facts are simply immutable.

Normally I would proclaim that any business can’t afford to skimp on its IT infrastructure, but given the current climate where just having a Windows XP machine connected to your network is a HIPAA violation, I’ve clearly got a certain target audience in mind for this post. That said, it’s not just medical practices that could benefit from taking a few minutes to read this post.

I’ve spent a lot of time the past months advising (and implementing) practices on how to make the move from the no longer supported Windows XP to Windows 7 and newer operating systems, and one thing has become readily apparent to me – there are two kinds of medical practices:

  • Practices that see technology as part of the patient experience.
  • Practices that only think about IT when it breaks.

The medical practices (and other businesses) that realize that their IT infrastructure is part of the patient (customer) experience tend to have made the realization that IT in a medical office is not just there to scan ID cards, print receipts or create patient forms, but actually adds substantially to the patient experience and bottom line of the practice.

Happy patients = more money!

That’s not a difficult concept right? I think everyone can agree that if a patient has a positive experience at your office they’re more likely to come back the next time something ails them. They’re also far more likely to recommend you to other potential patients (word of mouth marketing), leave positive reviews on rating sites, etc… Happy patients = more money for you. Simple!

A lot of medical practitioners and office managers appear to forget that the patient’s experience in their clinic is not just measured by the patient – doctor interaction, it comes from the everything they experience at your office. From the moment they walk in the door, from that first impression, the friendliness of the staff, the promptness of their appointment, the ease of filling out information – it’s all being judged by the patient and it ALL impacts your bottom line.

So, how does IT actually affect any of this? Well, let’s forget about silly little things such as multi-thousand dollar fines (per patient) when data is exposed due to poor infrastructure and / or running out of date operating systems and look at the ways that keeping your computers and software up-to-date actually affects your bottom line.

Faster computers (and modern operating systems) increase staff productivity.

It’s not just just the ability to run better, newer software, but multiply the 10 minutes it takes those ancient computers to start up by the number of staff you have and there’s a massive amount of wasted productivity hours. A lot of time is wasted every day because applications take forever to open / switch between, and all of that wasted time is time that you are paying staff for. If  you want to get more productivity from  your staff then give them the tools to do it.

Faster computers equal happier staff.

In my experience, there’s little that will annoy good staff in a good office faster than slow computers. It’s frustrating to have to not be able to move on to the next thing, especially when you have a patient standing there waiting for that document you sent to the printer 5 minutes ago.

If there’s one thing patients are especially good at picking up on, it’s the atmosphere in an office. When staff aren’t happy, you can be sure that patients aren’t, and that is going to have negative impact on their experience and willingness to return in the future or recommend  you to other potential patients.

Faster computers equal happier patients.

When you’re sick, tired or in pain, the last thing you want to do is stand around twiddling your thumbs for five minutes at the check in desk at your doctors office waiting for their EMR (electronic medical record) system to pull up your details. That should have happened almost instantaneously, and it would have if the aging computer had more RAM, a faster CPU or better connectivity to the server.

Get those patients checked in and out faster for a better patient experience and a less crowded waiting room.

Keeping your infrastructure up-to-date saves you money.

All computers break down, have issues and occasionally need repairs, but performing support tasks on older computers takes longer. Slower machines take longer to install drivers on, track down issues etc. It’s not rocket science.

As your infrastructure ages there tends to be more issues which require support and the cost of that support can escalate rather quickly. You might only see it as a $100 here, $200 there, but when this is happening every other week (even when you have contracted support agreements) it can quickly get to the point where you could have actually paid to replace aging equipment and had LESS support call-outs.

Upgrading / Staying up-to-date doesn’t have to be a huge expense.

A lot of small practices get sticker shock at the notion of spending many thousands (sometimes tens of thousands) of dollars to replace equipment that still essentially works. Most don’t realize that these upgrades don’t all have to be done at once. Unfortunately a lot of vendors won’t tell you that, instead going for the big “all in one” sell – but that’s another blog post.

Implement a rolling upgrade policy. Start with the oldest computer (or computers depending on how desperate the situation) on your network and get them upgraded – whether than means adding more RAM, SSD’s or a better CPU or simply replacing the whole machine. If you have a server, see if that needs upgrading too. In 6 months time upgrade another machine or two and continue to do so over the next two years. By the end of the two years you’ll have completed 5 upgrades (0 months, 6 months, 12, 18, 24) and have replaced or upgraded 10 machines without any one major expense.

Most small medical practices will have somewhere in the region of 10 – 20 machines, but you can adjust the plan to suit your infrastructure needs and budget accordingly.

On month 30, start the cycle again – upgrading the components of or replacing the machines first updated at month 0. Repeat the cycle over and over again and you’ll never have machines more than 2 – 3 years old running on your network.

You may also wish to annually evaluate your networking equipment and see if any performance gains can be made by upgrading aging switches / firewalls / routers to newer faster standards.

Remember that it’s not just your hardware.

Aging software can be a productivity drain almost as much as aging hardware. Be sure to evaluate new versions of the tools and software you use in your practice and determine if making the move to newer versions could increase productivity or will add features that improve security etc..

Speaking of security… Don’t forget those updates…

Again I’m going to gloss over the potential fines that medical practices and businesses can be slapped with if patient / customer information is compromised, and instead remind you of the cost of having someone come out to clean your network of trojans, spyware and malware. Good anti-virus and anti-spyware software is always a must, but none of it is perfect. No matter your operating system – Windows, OS X, Linux… make sure that you are installing updates regularly. These updates don’t just add new features to your system- they fix bugs, can increase stability and performance, and fix security holes and issues.

If your IT person (you do have an IT person, right?) recommends that you turn off Windows updates for performance, or because things “might break” then you need to fire them. The days of such things happening are long, long in the past, and the rare times that they do occur are far lest costly than the potential damage than can be caused by not running them.

While you’re at it, have your IT person or vendor upgrade the firmware on you routers / managed switches / firewalls etc….

It doesn’t cost a lot to be secure AND productive…

For most practices, if you put your IT infrastructure on a rolling upgrade cycle the cost becomes pretty negligible plus you get to avoid the major sticker shock of a one time upgrade.

If you start thinking about your IT as part of the patient (and staff) experience the outlay will more than recoup itself in increased productivity, repeat patients and positive word of mouth marketing.

Please Just Be Honest When Asking For A Link Removal

404 - Broken Links In Google Webmaster Tools

Can we just be honest when asking people to update or remove links?

It happens to all sites. Links move or change, posts occasionally get deleted, categories get restructured and despite your best intentions, you still have broken links coming into your site.

At this point you can either set up 301 redirects to a new location or relevant content, or you can reach out to site owners and ask them to alter or remove their links. Most site owners will be happy to update broken links, but a little bit of honesty will get you a lot further than trying to scare site owners by saying that Google is penalizing your site and the same will happen to them.

I’m seeing it happen a lot lately. Instead of just being honest and saying “Our bad, we restructured our site and don’t care to put 301′s in place” or “We deleted the content you were linking to” or (and perhaps most honestly) “we’re engaging in some reputation management”, most emails of this type appear to be defaulting to the “Google is penalizing us and if you don’t delete the link Google will penalize you and your site will never rank again” tactic.

The truth is that a handful of broken links on my site spread over thousands of posts isn’t going to result in Google issuing my site any kind of penalty.

While you’re at it, make it as easy as possible for me to find the link you want removed. Provide me with the name and URL of the post in which the link appears. Sure I could search for the URL you want removed but that’s more work for me. The easier you make it the more likely I am to actually do what you want.

Do not, ever, ever, ever send me a list of URLs from my site that include category indexes, tags etc. That’s pointless and making more work for me. Just 1 URL. That is all. Show me you’re not lazy and actually care.

Finally a tip for managing and detecting broken links on your own site.  You really should be fixing broken links yourself as it improves not just your SEO but also the user experience. If you’re using WordPress try using a plugin such as “Broken Link Checker” to stay on top of things. Regardless of what platform you use, you should also be using Google Webmaster Tools which also report crawl errors and broken links.

Where Are The Parents?

Facebook Social Media AbuseI read the following without a single shred of disbelief, but with a lot of sadness when it comes to parenting skills of many of my peers and societies reaction to such a state – which is to let state be the corrective force.

The channel found that British police deal with around 20 “social media abuse” cases a day. In the last 3 years, there have been 20,000 investigations involving adults and almost 2,000 targeting children – although, since around a third of police forces did not give up their data, the number must be higher. Over 1,200 children have been “charged with a criminal offence or given a caution, warning or fine,” including four 10-year-olds and one 9-year-old. 

I have two questions to ask:

  1. Why are the children being cautioned or charged instead of the parents?
  2. Why are these parents allowing their children to use the internet without monitoring their activity?

Sadly, I suspect the answer to both questions to revolve around the same idea…

You Must Ditch Windows XP Now!

IE11 Will It Run On Xp

WiIll IE11 be available on Windows XP?

Will IE 11 exist for Windows XP? Are you kidding me? People like this crack me up!

Medical practices all over the company are scrambling right now to replace computers running the decrepit Windows XP operating system in order to avoid a HIPAA violation and remain meaningful use compliant. All other businesses and private individuals would do well to realize that once the April 8th deadline rolls around, your Windows XP operating system isn’t just less secure because it’s not receiving patches and updates, but is less secure by orders of magnitude because it will never receive a patch or update for a security exploit even if the exploit is widely publicized and used.

The very first month that Microsoft releases security updates for supported versions of Windows, attackers will reverse engineer those updates, find the vulnerabilities and test Windows XP to see if it shares those vulnerabilities.  If it does, attackers will attempt to develop exploit code that can take advantage of those vulnerabilities on Windows XP.  Since a security update will never become available for Windows XP to address these vulnerabilities, Windows XP will essentially have a “zero day” vulnerability forever.  How often could this scenario occur?  Between July 2012 and July 2013 Windows XP was an affected product in 45 Microsoft security bulletins, of which 30 also affected Windows 7 and Windows 8.

As Tim Rains explains, anti-virus and security software won’t help you either.  So, unless you as a business or a private individual are happy with unsavory types (you know, besides the NSA) having access to your patient / customer patient databases, email, credit card numbers, your web browsing history, and being able to use your computer as a zombie bot to steal from others, and any potential fines (as a business) for data breaches, then get rid of Windows XP now!

The cost of the upgrade will be far less than the cost of potential consequences.

Windows 8 – Good Enough For Pirates!

Windows 8 Pirate EditionBrowsing the web I see a lot of people complaining about Windows 8 and I automatically assume that 90% of those people have never used it. All of the people I know who have actually used it like it, or at least don’t complain about it. With so much apparent hate for Windows 8 spewing forth from the comment sections of most tech news sites, I was surprised to read that Windows 8 was the only non-video search in the top 50 searches on Kickass Torrents in 2013.

There is no central database of searches available, but Kickass.to, one of the top three torrent sites in terms of visitors, was kind enough to share the most popular search terms of 2013 with us. This list is based on millions of searches and gives an indication of what people were looking for on BitTorrent networks during the last 12 months.

Adult related searches are surprisingly absent among the popular search terms, and the same is true for music and game searches. The only non-video search in the top 50 is Windows 8 in 40th place.

The only non-video search in the top 50, eh? No mention of Linux, Windows 7, Windows XP, Photoshop, Creative Suite, video games, Android or Apple apps for rooted devices, or chart topping music albums… It’s all Iron Man 3, World War Z, Breaking Bad, Game Of Thrones, Star Trek: Into Darkness, and… Windows 8.

I guess people don’t hate it enough to not pirate it! And the first person to suggest that people are only pirating Windows 8 to “try before they buy” is getting a swift kick to the groin because we all know that’s plain bollocks.

Tablet Productivity – A World Of Compromise

Tablet ProductivityBack in early November I wrote a post about challenging my tablet productivity assumptions, and set out with the goal of leaving my laptop behind (as much as possible) and doing most, if not all, of my work on my tablet.

As per my previous post, this adventure in mobile productivity meant pairing my Nexus 7 with a nice Sharkk Bluetooth keyboard (which I can’t rave about enough), making sure I had plenty of backup power (not such a great experience) and finding solutions to productivity problems that aren’t even a second thought on my laptop.

In undertaking this challenge I really wanted to reverse my opinions about iPads (and tablets in general) being mostly media consumption devices (or Tonka toys of general computing) and come out swinging in favor of tablets being awesome productivity machines. I’m afraid that after a month of working as exclusively as I could on my tablet(s), there were simply far to many compromises made to quality and efficiency for me to call tablet productivity effective.

Yes, I’m sure there are some cases where people are hyper-effective working on their tablets, but those are niche cases. I’m sorry to inform you but your niche case does not make a strong argument for mainstream productivity.

Before I get into what I was doing and attempting, let me clarify that I DO NOT consider checking Facebook, answering email, instant messaging or anything like that productivity.

As a marketing consultant even I can’t justify hours of Facebook activity as productivity, and if you’re spending hours answering your email then you are clearly doing it wrong.

Anyway, when working for clients and equipped with my laptop, I find myself living in Excel, Word, PowerPoint, Dreamweaver (and the awesome Notepad++), Photoshop, Audition, Premiere, RDP, VNC, various EHR and practice management solutions, and of course a browser.

Finding workable solutions for the Microsoft Office suite was easy enough – I just do everything in Google Apps (which I am fully vested in for my non-client work anyway), but there are issues such as formating of exported documents, and added steps that frankly  make it a pain in the backside to move stuff between Google Apps and clients that are using the Microsoft suite.

Don’t get me wrong, Google Apps is awesome for how I use it, but I’ve yet to encounter a non-Microsoft product that exports/imports perfectly with no formatting errors.

Dreamweaver, Notepad++ and Filezilla proved to be an interesting challenge to replace, but after testing a number of apps I have absolutely fallen in love with DroidEdit Pro. It’s an awesome text and source code editor with syntax highlighting for lots of languages (HTML, CSS, C, C++, C# Python, Ruby and more…) as well as SFTP/FTP/Dropbox  support and much, much more. If you’re a developer and need to get your hands dirty in code while you’re on the go without your laptop, you can’t do much better than this app.

I gave up trying to find workable mobile replacements for Photoshop, Audition and Premiere. Yes, there are a lot of stopgaps and half measures which are “kind of almost” passable, but the compromise in quality and features is not worth the the hassle. It’s much easier to stay with full featured desktop apps that also have the processing power to plough through the work in a decent amount of time.

While finding mobile replacements for desktop applications has been very hit-or-miss, even when I do find a suitable replacement there are always compromises to be made. Those compromises may be in terms of quality, the ability to easily export in formats that my clients can use, or simply because doing the work on the table can involve more steps (such as getting source materials to and from the tablet).

Did I mention that it also takes longer to do almost everything on a mobile device? Even with my nifty Bluetooth keyboard I’m still not as fast as I am with a laptop.

Access to files has also been a major issue. Yes there are lots of solutions out there such as Google Drive, Dropbox, SkyDrive and more. I use all of the cloud storage/sync solutions I’ve mentioned and they’re great when I need to get to an invoice template but downloading a 30MB .PSD or a 1Gig+ .wav audio file for editing? Most of these services are just far too slow and storage space/bandwidth constrains on mobile devices may be a concern.

BitTorrent Sync has proven to be a lifesaver in that regard. Not only does the mobile app allow me to selectively download files from my shares on my home server, but it also allowed me to set up shares on desktop computers at my clients offices so I could have access to files, fonts, graphics and other assets that I use in my work but would normally be on my laptop. That way I can use their machines to do the work and have access to assets that I need without hauling my laptop around.

The solution works and doesn’t take long to set up, but, it’s a compromise that has to be made in order to work on a mobile platform.

I think it’s fair to say, that mobile devices are not yet ready to knock the desktop PC or laptop in terms of productivity.. In doing this challenge, I found myself not just using my Nexus 7, but also having to use my iPad at the same time. Some of my clients provide me with a dedicated workspace and computers so I was able to do a lot do the work there that I couldn’t do on the tablets and not impact my productivity. For my other clients I simply had to bring a laptop to remain as productive as possible.

It’s not all doom and gloom however. While I may not be able to replace my laptop (yet) I have found that I can replace large segments of my workflow and get by enough that I don’t always need to carry a fuller featured device around.

Take audio recording as an example. My Nexus 7, 4 or iPad coupled with the iRig Mic Cast, iRig Recorder or Hi-Q MP3 Recorder creates a nice portable rig for on the fly podcasts with minimal editing abilities. There are a multitude of apps for managing servers, RDP, VNC, time management, invoicing, blogging (this entire post has been hammered out on my Nexus 7 using the WordPress app) and almost anything else you can think of – so you can certainly get by without your laptop, but they are mostly one-trick ponies.

I expect that as mobile productivity apps mature, and someone figures out that for folks like me productivity requires true multitasking, then one day I may be able to shed my laptop for a iPad 17 or Nexus 21 – I just don’t see it happening anytime soon.

Side note: Having not yet gotten my grubby mitts on a Surface or other Win 8.1 tablet, I obviously can’t comment on those from a productivity perspective.

Powerocks Magicstick – Not So Much Power, More Stick (Review)

Powerocks Super MagicstickDisclosure: I was able to keep the review unit mentioned in this post.

TL;DRThere are higher capacity chargers out there for a better price.

The folks at Powerocks were kind enough to send me a Magicstick extended battery (Model: model SM-PR-2AB) for testing at the end of November.

The Magicstick itself is a small rechargeable 2800 mAh lithium ion battery (Input: DC5v / 0.55A, Output: DC5v /1.0A), with 2 USB ports (one micro, one full), comes in 8 colors, costs $49.99 and  that looks so much like a flashlight that it could be mistaken for maglite. It comes complete with all the cables you need for charging USB (micro USB) devices, although you’ll need to use your own cables if you’re charging an iPhone.

It takes between 5 and 6 hours to charge the Magicstick which can be accomplished via a USB charger or AC wall outlet charger (not supplied) or any compatible high current USB port (using the supplied cable). The amount of charge remaining in the Magicstick is indicated by an LED light that activates when you depress a button on the top of the device – Blue light = 70% – 100% full, Green light = 30% – 70% full, Red light = 1% – 30% full.

As you can see from the picture of the box (and the their website), the Magicstick promises up to 2 full charges for smartphones (including iPhones and Android phones), cameras, portable gaming devices, Mp3 players and more. This extended battery is not for charging tablets. While it technically can provide a charge to an iPad at best you’d only get about 10% charge on an iPad Air.

I tested the Magicstick with my Nexus 4 and was unable to get the the phone to ever charge above 85 – 87%. The Nexus 4 has a 2100 mAh capacity battery so it should have been able to receive at least 1 full charge but after testing in various scenarios I was unable to achieve this.

I tried various scenarios, always starting with a 100% charged Magicstick which had been left to charge overnight for 12+ hours) such as charging the Nexus 4 while it was powered on (but not in use), with starting battery level at 7%. I would assume that charging “powered on” is the most common scenario for most users who require an extended battery.

I also tried charging with the Nexus 4 while the device was powered off and fully depleted (the phone had shut itself down from lack of power). In either case I couldn’t get the phone to charge above 85 – 87%.

The iPhone 4S and 5S have 1432 mAh and 1440 mAh batteries respectively, so should achieve a full charge without problem, however there is no way, even on paper that they could achieve two full charges.

I don’t have a feature phone to test the Magicstick on, but I could see it (on paper) living up to its promise of “up to 2 full charges” on such a device. But for modern smartphones the Magicstick simply won’t cut it as a decent extended battery.

Powerocks do make extended batteries with larger capacities, such as the Magic Cube 9000 and 12000 but these are quite expensive at $89.99 (9000 mAh) and $109.99 (12000 mAh). A quick search of Amazon has extended batteries such as the Anker Astro E4 13000mA and the New Trent iCarrier 12000mAh getting great user reviews with higher capacities and lower costs than the Magic Cube.

At the end of the day I simply can’t recommend the Magicstick, even at the $40 – $50 price range.  I wanted to like it, I really did, but other manufactures make higher capacity, visually and technically similar devices such as the Anker Astro Mini 3000mAh Ultra-Compact Portable Charger which comes in at a full $10 cheaper.

Playing With My Magicstick

Get your filthy mind out of the gutter. It’s not that kind of a Magicstick.

Today I’m testing the Powerocks Magicstick, which was kindly sent to me by the folks at Powerocks for review (consider that disclosure).

Considering that I’m currently re-evaluating my opinions of tablets as productivity machines, this portable charger could prove to be a handy companion power source as I attempt to go “mobile first”.

The Magicstick itself is essentially a small rechargeable 2800mAh lithium ion battery, with 2 USB ports (one micro, one full), that looks so much like a flashlight that one of the girls at Pinnacle Brain & Spine Center actually asked if it was a maglite.

I’ve taken a few pictures of it next to the Nexus 7 so that you can get an idea for the size, and I’ll post more about it in a few days once I’ve had a chance to charge/discharge it a few times as my mobile devices need charging.

Powerocks Super MagicstickPowerocks Super Magicstick