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How are your providers accessing CPS during patient encounters?

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Last Post by [email protected] 6 years ago

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tnc

(@tnc)

Posts: 517

Honorable Member

Topic starter

We currently have wired (fat/thick clients) workstations in exam rooms which have worked well for us over the years but some of our newer providers have expressed interest in laptops or tablets. I would like the best of all solutions (great user experience, reliable, low maintenance, reasonable cost). I realize that not all of the things in my wish-list will be possible but I would like to know what has worked for you guys and what has not. I purposely left out security in the wish-list because I have a game plan for that already in the works. I heard recently that someone was using a fat client over Wi-Fi but I think that is incorrect information and sounds like a very bad idea with locked charts and data corruption.

My main questions about "what works" are:

-Laptops or tablets, which would be better? (are iPads or mouse-less tablets usable with our current iteration of CPS?)

-BYOD or clinic provided (I would be using something like Ruckus Cloudpath for onboarding)

-Terminal Services or Citrix (knowing I will have to buy TS licensing to use Citrix anyway, is Citrix still worth the additional cost?)

-802.11N? 802.11ac, other? What has worked/not worked for you guys?

-Are you utilizing templates to make CPS more "tablet friendly" and to use a touch screen?

-Dictation-How are your providers dictating into a thin client? We use Cspeak Anywhere for many providers. I am aware of SpeechMike Anywhere add-on which lets you use an iPhone. What else is out there which works?

I hoped to put this off until we get a "cloud based" CPS solution but people are asking for solutions now. Honestly, I wished they would at least have continued to develop that http://CPSJBOSSSERVER:9080/centricityps/emrgwt/Emr.html#Login which is effectively an on premise cloud. It works great but has very little functionality.

Thank you in advance for any input!

Mike Zavolas
Tallahassee Neurological Clinic

Posted : January 31, 2019 2:29 am

swestfisher

(@swestfisher)

Posts: 132

Estimable Member

WE have no fat clients, just a farm of terminal servers accessed with RDP. We also have HP thin clients in the exam rooms. One group of providers will connect to CPS on their laptops and then carry their laptops to and from the exam rooms not using the thin clients at all. Another group of providers leave the laptop on their desk and "steal" the terminal server session from it on the thin client. At the end they will disconnect (not logoff) from the session on the thin client, go into thier office, and "steal" it back. We force only one logon in the farm so the session is closed on the previous machine if it has not been disconnected.
Steve

Posted : January 31, 2019 2:41 am

SLHV

(@slhv)

Posts: 478

Honorable Member

Like swestfisher, we also have no fat clients. We're all MS terminal server. We haven't found any reason to use (or pay for) Citrix since 2006, and I see less and less reason to consider it.

You have options now with virtual desktops if that's an infrastructure option you're considering for other reasons.

I think laptop or tablet is a user preference, although IT's typical responsibility to fix/replace the darn things makes me not want to encourage their use. I can't imagine using a display of less than 1440 x 900 or maybe larger (we all use 1920 x 1200 I believe). CPS so poorly manages the display I'd be afraid to use any lower resolution.

BYOD vs provided is more a policy question. BYOD is likely to end up costing a lot of time/money in IT time maintaining 500 different versions and types of devices, but the users are much less likely to break them since they own them. Reverse that for the clinic provided.

I'd say 802.11ac is the right choice now. It's been out quite a few years and currently provides the best performance. I'd stay away from Meraki gear. I've seen their support staff sniff LAN traffic without any specifically granted privilege by an authorized administrator. As cloud-administered hardware, any action that can be done on local hardware is administered and available in the cloud, including packet captures. This was about three years ago, so perhaps they've resolved that security flaw by now.

Several of our providers have used Dragon Medical for dictation in the past. I don't believe any of them still use it.

-dp

Posted : January 31, 2019 9:37 am

tnc

(@tnc)

Posts: 517

Honorable Member

Topic starter

Awesome, thank you for the information. I never heard that about Meraki before. Fortunately I have a Ruckus infrastructure but would have to replace to get 802.11ac.

Mike Zaqvolas

Tallahassee Neurological Clinic

Posted : February 1, 2019 7:11 am

tnc

(@tnc)

Posts: 517

Honorable Member

Topic starter

Perfect. I have been doing the remote connection to desktops for years now. It has worked out great and I really can not think of any downside to doing it that way.
Thanks
Mike Zavolas

Tallahassee Neurological Clinic

Posted : February 1, 2019 7:13 am

SLHV

(@slhv)

Posts: 478

Honorable Member

If I hadn't personally witnessed Meraki support doing packet captures with no accountability I would find it hard to believe. I typically expect such established companies to include some type of access controls that the customer manages before their staff can gain management access.

About once a year I get a sales email from Meraki. I ask about this and never get a response.

I wouldn't necessarily say you need to replace all of your 802.11n access points with 802.11ac. It depends on a number of factors. How many clients per AP? Are you observing throughput issues on any APs? If so, you might just need to add another AP to spread the load.

To add a little more on tablets, we have one provider that liked to use his iPad for awhile for CPS. I don't know if he still does regularly. He figured out most of the tricky swipes (two fingers sliding up does something, across does another, etc) and found it convenient under some circumstances.

-dp

Posted : February 1, 2019 7:51 am

tnc

(@tnc)

Posts: 517

Honorable Member

Topic starter

Are any of you guys using iPad or Android devices for this instead of Windows/RDP?

Posted : February 1, 2019 8:48 am

swestfisher

(@swestfisher)

Posts: 132

Estimable Member

We have looked into tablets, but our providers found the RDP on iPads and Android to be too cumbersome for be able to work efficiently. If there were a true web based CPS or app for the devices...
Steve

Posted : February 1, 2019 8:54 am

tnc

(@tnc)

Posts: 517

Honorable Member

Topic starter

Someday..... maybe? lol

Posted : February 4, 2019 1:13 am

[email protected]

(@paul-distasioglfhc-org)

Posts: 6

Active Member

Thanks Mike

We use laptops here. We have Stand alone devices in the Exam Rooms but are moving towards more of a Computer on Wheels Laptop model.

Best,

Paul

Posted : March 7, 2019 6:52 am

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