Things To Consider When Buying Computers For Your Medical Practice

Things To Think About When Buying Computer Equipment For Your Medical Practice

Money can be tight when you’re starting up your medical practice or small business, and it can be very tempting to save money by buying cheap computers –  but this decision can end up costing you more in the long run in terms of lost productivity and early equipment replacement.

TLDR; Buy the most powerful PCs (for stationary positions) and laptops (for “mobile” staff)  you can afford, with the pro version of the latest Windows operating system (ie: Windows 10 Pro). Don’t worry about dedicated graphics – focus on getting the best CPU, with the most RAM and a solid state drive.

Here are some things to consider to help you buy the right equipment, keep costs down, but also future-proof yourself and improve your workflow.

Apple or Windows?

Windows. You’ll be hard pressed to find a server based EMR or practice management software that runs effectively on a Mac unless you’re using remote desktop or some other solution to connect to a dedicated server. Even web-based solutions require bridging software to talk to their peripherals, most of which will not work with Apple products. While there are ways around this, and it is certainly possible to have an Apple based office, save yourself a headache and the cost.

Do I need desktop computers if can we use laptops and tablets?

Straight answer – it depends on what you’re using them for:

For the reception, office manager, and other admin staff, which is an essentially stationary position, I would always go with actual PCs.

Check-in, and check-out positions tend to require extra peripherals to be connected directly to the computer such as webcams for taking pictures of the patients, signature pads, card scanners and credit card terminals. These all require extra ports to be available on the machines which laptops typically do not have enough of.

PCs also allow you the flexibility to have dual monitor setups which make working in an EMR considerably easier, especially when you have other programs as well. This increases efficiency, reducing the amount of time your front desk staff spends processing each patient.

It’s also easier to upgrade components in PCs than laptops which enables you to use the hardware longer and at a lower cost.

For staff who are mobile within the office, such as physicians, mid-levels, and nurses that are seeing patients, I would go with laptops.

Laptops are portable enough that you can bring them into the exam room with you and document while you are with the patient. I’ve seen this save between 5 and 10 minutes a patient allowing for a higher volume of patients to be seen during the day. It also helps prevent issues where a provider may forget to document something that was noted during the exam if they become distracted or are diverted after leaving the exam room and have to document later.

I wouldn’t use tablets. Tablets, while portable, tend to be underpowered and documenting on them tends to be considerably slower, even when they are equipped with a keyboard. – Sidenote – I’ve seen clinical staff almost cry when I’ve asked them to work on a device where the keyboard didn’t have a numeric keypad…

Use of tablets can also lead to issues relating to printing unless you take extra steps to prevent that.

Are you using a server or web-based EHR/EMR?

Server-based EMRs, whether the server is onsite or offsite, typically require you to install dedicated software on your computers in order to be able to use the system. In my experience, this software is typically enough to bog down slower computers, which reduces efficiency, and the requirements for this software only increase over time.

Web-based EHRs tend to have much lower requirements than server-based. Often all you need is a modern browser such as Google Chrome, Microsoft Edge or Firefox, and usually a small lightweight piece of software to bridge the gap between the browser and the peripherals.

Even for web-based solutions, I would caution against skimping here. Your PCs will have a lot of peripherals attached to them, many of which will also be running their own software. The combined load can significantly slow down older or less powerful PCs resulting in reduced efficiency, unhappy staff, unhappy patients, and reduced patient throughput.

What about my network?

Your network is definitely an area not to skimp on – all of your data, print connections, file shares, internet access, streaming audio and maybe even your VoIP phone connections will travel over your internal network so it had better be fast –  although fast doesn’t mean that it has to be expensive. Gigabit switches are cheap these days, and every switch on your network needs to have gigabit capacity or you will create a bottleneck and slow things down.

Your router is no exception. I’ve seen offices with Gigabit networks hampered by poor or aging routers acting as both their firewall and DHCP server. For example, I was recently at an office that despite having a robust network was using an older Cisco Security Appliance as their router and DHCP server. The appliance in question could handle 40000 packets per second, which was causing a bottleneck and resulted in IP addresses not always being released or assigned (which meant devices were sporadically unable to connect to the network). Replacing it with a newer router for less than $300 increased the throughput to 2 million packets per second and alleviated the issues.

Don’t use domestic wi-fi equipment for your office or guest networks. They’re just not built to take the number of devices you’ll have connected to it. For example -let’ss say you have 7 laptops, 10 cell phones (that’s one for each member of staff – let’s be honest everybody wants to use work’s data instead of their own), 4 tablets (used for patient check-in), 2 streaming audio devices such as Sonos (it’s nice to have music that’s not muzak in the clinical area), and you’re already up to 23 devices before you even think about adding a guest network.  Equipment such as Ubiquiti Unifi is as cheap as if not cheaper than many home wi-fi solutions but will be far more reliable with much higher capacity and allow for easier expansion.

What do I recommend?

Every situation is unique but in general,  I recommend that you focus on interoperability, expandability, performance, and cost first.

The easiest way to achieve this is with Windows-based PCs. They’re relatively cheap, work with almost everything and won’t limit your choice of EHR or practice management solution.

When purchasing, focus on getting the best processor, the most RAM (8 gigs minimum but 16 would future-proof you) and an SSD (solid state drive). It doesn’t have to be a large SSD – 128 Gigs should suffice most computers as important file storage should be centralized and backed up. You could go with a traditional hard drive here if storage space was more important to you than speed.

Don’t worry about spending money on graphics cards – the integrated graphics chips on modern PCs are more than a capable of driving dual displays and anything the standard office environment can throw at them. Your staff should not be playing Fallout 4 on them.

Laptops should also fit a similar description, but the important thing here is the form factor and screen resolution. To get the most efficiency out of your EHR you’ll require a screen resolution of typically 1920 x 1080. Smaller screens will start hiding menus forcing you to click around more.

The form factor or size of the laptop is a matter of personal preference. Keep in mind that you’ll be carrying the laptop around all day, so lighter is better, but don’t get too caught up in it. Most laptops, even the larger ones with full numeric keypads, are light enough to tote around all day as most of the time you’ll put them down when you get in the room.  An SSD is essential here though, as they have no moving parts which can help avoid damage which would occur to a traditional hard drive if there was a drop or bump.

Obviously, I haven’t covered everything that you need to think of here, such as implementing a refresh cycle, servers, on-site and off-site backups, redundancy etc, but I hope I have given you a good place to start.

What’s Your Reputation Worth? Why It’s Okay To Say “I Can’t Do That”…

Know Your Limitations

When I started freelancing and consulting, back when I was young, good-looking, idealistic and proudly rode my Brontosaurus to work, I made the same mistakes as many budding freelancers and consultants –  I accepted work that I really shouldn’t have because I wanted to ensure that next paycheck. Hey, don’t judge me! Do you have any ideas how much it costs to feed a Brontosaurus?

While I certainly delivered on my end and my clients were always happy, it usually meant a steep learning curve for me as I tried to learn new technologies in order to be able to deliver on the promises I made – it also meant a lot of stress and working a lot more hours than needed – hours which came out of my my free time because you can’t charge the client for your lack of knowledge.

Looking back with more than a decades worth of hindsight I find myself wondering what damage would have been done to my reputation had I not been able to deliver, or if clients were unhappy with the finished project?

I find myself wishing that someone had told me (or that I was clever enough to figure out) that it was okay to turn down work that wasn’t within my area of expertise and to use the extra time to expand my skill set. A little extra hunting for contracts in my field, instead of taking every job that came for fear of not getting another one, would have led to a lot less sleepless nights.

Unfortunately for many freelancers and even firms, this habit stays with them long after they’ve graduated beyond Padawan Consultants. It’s a hard habit to break – that paycheck is very tempting when your health insurance is on the line.

We need to accept that doing what is best for the client is ultimately what is best for our business and our reputation. Reputation is all we have.

It’s okay for us to say that we can’t do a job. It’s okay for us admit to potential clients that we don’t know something (Pro-tip – it makes you look smart and confident to acknowledge your own short-comings), and if we refer clients to people who can deliver quality work, the client and those we referred them to are likely to send work our way in the future.

Yes, we’ll have to hustle a little harder to get that paycheck in the short-term, but long-term being honest with yourself and potential clients about our abilities is the best deal for everyone, and will do wonders for your reputation.

How Not To Apply To Guest Post (And 5 Tips To Avoid The Circular Filing Cabinet)

How Not To Apply To Guest Post

I received the above application to guest post on my blog this morning, which set my teeth on edge.

Everything about this generic, impersonal, templated application is an insult to the owner of any blog that receives it, and it would have ended up in the virtual circular filing cabinet if I’d had my morning coffee and wasn’t feeling slightly cranky.

Let me offer prospective guest bloggers some tips to avoid having your email deleted by site owners like myself:

1. Read My Blog

Read my blog, listen to my podcast, find out who I am and what makes this blog tick.

Even skimming the archives and poking around for 5 minutes would help you avoid such stupid mistakes as starting your email with “Dear Editor”  and offering  me a piece of your “comprehensive research”.

2. Flatter Me

Stroke my ego – Seriously! Tell me why a certain post is your favorite, or about something that I wrote that really got under your skin and made you want to roar with anger.  It lets me know that you’ve got a genuine interest in my site, and implies that you may have a good feel for what sort of posts fly well with readers.

3.  Tell Me What You Are Going To Post About And Why?

It’s not enough to tell me that you want to guest post, you have to tell me what you want to post about. Get me thinking, whet the sword of interest and make me want to read your post. Keep it brief, but a few tantalizing details about your post can go along way to making me agree.

4.  Link To Your Blog And Examples Of Your Writing

It doesn’t matter how good your pitch is, or how tantalizing your idea sounds, without being able to get a feel for how your writing style and see your blog there’s no way I’ll agree to a guest post.

If you’re not writing for yourself, why should you write here? Also, there’s no way that I’m going to go searching for your blog if you haven’t linked to it. Insta-bin!

5. Keep it brief

My time is valuable. While my time may not always be money, it could me my relaxing time, time spent with my beautiful wife, or playing with the kids. Every paragraph you add to your email dramatically increases the odds of it being sent to the trash.

Try to keep your email about 2 paragraphs long.

Bonus Tip: Don’t Waste Your Time (Or Mine)

This tip is specific to my site so I wanted to separate it out from the others.

Don’t waste your time applying for a guest post if all you want to do is shill a product. I make a large distinction between people who want to write guest post that bring value to my blog versus people who are trying to market a product.

Guest posts from bloggers who are writing to reach a new audience and share a genuine opinion or helpful tip, bring value to my site and to themselves.

Marketers who are looking to guest post just to have their product mentioned don’t bring value to this blog, but they can apply to have me do a paid and fully disclosed review. All reviews come with the caveat that they will be 100% honest (which may not be good if you’re afraid of criticism).

Developer Productivity Tip – Evernote As A Searchable, Portable Code Snippet Repository


One of the coolest things about developing especially when working with an open source product like WordPress, is that if you have a problem the chances are that someone else has already developed a solution for it.

Need a piece of code to prevent YouTube videos from overriding your theme and messing up your content? Somebody has done it. How about preserving the share count on your Twitter buttons after a change of URL? That’s out there too.

If you know how to search for it almost everything you could need is out there, documented and explained by somebody else and ready for you to build upon. No need to re-invent the wheel over and over again. Pretty cool right?

Yes, it is pretty cool if you can actually find what you need amongst the pages and pages of search results, most of which are only vaguely related to what you need or are years out of date. You can spend literally hours looking for that one solution to a problem and when you find it, if your forget to bookmark it or save it you’ll spend hours looking for it again next time you need it.

What if you could have one central repository for all of the code snippets that you come across, complete with images, diagrams and context, that you could access from anywhere?

Using Evernote you could access these snippets from any browser or your cellphone, and they are easily searchable, and can be tagged in ways that make sense to you. Need  to add a function to change post formats for a single category on save? It should be really easy to find if you’ve tagged it appropriately and even if you haven’t Evernotes build in search only has your snippets to wade through instead of the entire internet.

I know Evernote has been around for a long time. I’ve been using it for years but honestly found little use for it, despite actively trying to find use for it, until I started using it to store code snippets that either I have developed or that I’ve found on the web.

Most days someone that I follow on twitter will link to a cool code snippet or function, or I’ll stumble across a cool tip or piece of code that I have no use for right now but may in the future. With a quick click of the Evernote Web clipper (available for IE, Firefox, Chrome and Safari) I can save and tag that code in case I ever actually do need it.

The best part of all this, beyond the time saved  by having this repository of snippets always available to me, is that the whole thing is entirely free. A free Evernote account coupled with some free extensions is all that it takes and I get to save time almost every day, instead of hunting down solutions on Google and in forums that I’ve already saved to cloud.

20 Tips for creating fresh ideas

We all need fresh ideas. From our personal lives to our blogs, from business to entertainment, rehashing old ideas gets, well old, and very quickly.

It’s good to have variety, it’s great to have spice and it’s even better when we come up with an idea that nobody else has, or is implementing. Those kind of ideas lead to happiness, profit and in my case an 18+ hour work day.

I’m posting 5 of my favourite tips from Daily Blog Tips “20 Tips for Coming Up with Fresh Ideas”, which I couldn’t resist linking to simply because they’re first tip is so me.. “Be really grumpy!”

  • Be really grumpy! Keep track of the things that annoy you. This is a great place to start, as you know the problem intimately as well as being the first customer for any solution.
  • Go people-watching. Unleash your inner spy! Spend time watching people go about their everyday lives. What are they doing? How do they do it? Can you spot any obvious problems?
  • Distract yourself. Have a change of scene. Do something that you love doing that has nothing to do with your business or blog. Get lost in what you’re doing. Often we come up with solutions when we’re not even thinking about the problem in the first place.
  • Critique everything. Question everything, and ask yourself “why?”! Intelligently analyse your environment and think of improvements. See what lessons you can learn about the good and bad things in your environment. – (It’s what  kids do all the time – Paul)
  • Think like a child. Children have a fantastically simplistic and candid view of the world, something we lose as we become adults. Employ a strong sense of curiosity and simplicity when looking for solutions. So many things in this world happen due to convention or habit, so thinking like a child helps to break this pattern.

Guest Post: Aaron Wall – Tips on using video in SEO

I have a special treat for you guys today. Aaron Wall of SEO Book has done a special guest post for O’Flaherty with tips about using video in your SEO. Enjoy!

I think video is a huge boon in many markets. It does an especially strong job of conveying trust to get people to want to learn and/or buy from you, showing things that are hard to describe with words (visualizing them somehow makes them more real … that is why so many e-books have fake covers after all), and sharing humor (as laughter is contagious and video can put you in an atmosphere where others are showing an emotion with clarity).

I added a bunch of 5 minute videos to many of my SEO tools and saw a drastic decrease in support queries. Some people who are too lazy to read a 10 page how to guide will gladly watch a few minute video to learn how to get the most out of using a tool.

In addition to those benefits, video is also easy to syndicate to other sites (via embed widgets you offer directly or via YouTube). If someone embeds your video in their blog they often link back to your site (especially if you use watermarks and/or aggressively brand your site in the video) plus someone embedding a 5 minute video from you  tells your audience that they really trust you.

I think the singular biggest error many people make when syndicating video to YouTube is not also adding more value on their own sites. A transcription of the video placed on their own site adds a lot of descriptive keyword rich text that they can rank for, plus adding a bulleted list synopsis to your own site ensures that your site aspires to remain the destination rather than letting YouTube get all the links you earned. I tried to do a pretty good job of the later when I posted the videos to my blog, but my videos sub-domain is still a bit sloppy and could use some work.

With video content Google does not have much textual content to weigh the videos against, so it is best to use short keyword dense descriptive titles with meta descriptions that help back them up. On many of the videos I submitted to YouTube I made titles that were a bit too long and perhaps spammy to be optimal.

My wife has been playing around with YouTube and has  done better than I have at getting her videos included in the search results than I have.

Six more bonus video optimization tips:

  • When in doubt, shorter with better clarity is typically better than comprehensive. And slower / calmer voice is better than quick speaking.
  • Annunciation matters. If you have trouble speaking clearly for long periods of time practice, and then record in smaller chunks. Buy a nice microphone with a pop filter. It is worth it. It makes everything you say more clear.
  • If you post to your site and YouTube try to use a different title on your blog such that you can try to rank for a wider net of keywords.
  • If you have the time to it may be worth submitting to Google Video, MetaCafe, and a couple of the other video sites. Some of them pass link weight and many of them have good authority.
  • Read this TechCrunch post …it offers lots of great viral video marketing tips.

Email makes communicating easier! Right?

Email is supposed to make communication more efficient. Yeah right! Most people don’t know how to use email effectively and the result is multiple time consuming emails being sent to clarify what would have been communicated in 15 seconds on the phone.

IT Security has posted “Hacking Email: 99 Email Security and Productivity Tips“. The tips cover every thing from etiquette to productivity and communicating effectively. A definite must read, even if you already consider yourself an email guru.

One of the largest problems I face when dealing with my inbox is the sheer volume of it I receive. Eric Mack (via Scoble) has a great solution for clearing out overflowing inboxes:

if an email takes more than two minutes to respond to, I delete it.”

Maybe that’s a little extreme. Maybe I’ll try:

“If an email takes more than two minutes to respond to, I’ll call you.”

That should help avoid all those emails looking for clarification. Nothing indicates tone better (other than face to face) than your voice!

Oh, here’s a quick idea.. I’ll just send a GTalk voice message to you 😉