EMR, home grown and store bought

[Kursk]

What are the biggest challenges for you in your environment when getting staff and other MDs to use computers?

Poor typing skills
Poor mouse skills
technophobia
Time pressure
Refusal of formal training
Old hardware
difficult software
time
Capital
add yours here

Right now I am dealing with typing intense application. Even with autotext, autocomplete, autoformat etc users still are having trouble typing. Workflow/cost/ROI do not allow dictation/VR at this time.

[witchdoc]

Some physicians especially the older ones have computer phobia, how many of you look up labs at the hospital instead of asking nursing staff or residents.

[ozzie]

You covered all the bases pretty much .
From my world rolling out software in general has the problems you listed some more than others..
You end up with two options
1. Feed the staff to the wolves and go thru pain and disruption
2. Slow interegration with a timetable and milestones and the usage and expansion process is controlled.
For the most part I prefer 2 but in some cases call for number 1..
I will be the firt to admit I cnanpt touvh type but a Ic an peck about 30 words per minute as you cna see LOL.
If using #2 then start be having staff use Mavis Beacon http://www.mavisbeacon.com/ give toys bonus etc for staff that achieve levels within a time frame . It's a learning process,which ever way you cut it.
Have a clipboard where staff can write problems look at these daily and forward to relavent parties.
Weekly meeting with the weeks problem sheets telling all what has been resolved what status of the rest of the problems are. This encourages staff to point out bugs etc and shows that you care about the input.
Don;t make unrealistic goals.. If you have a total paper office, start by getting PC's and connecting to the internet. For the technophobes find out their hobby, then show them how to find out info on their hobby. Maybe even find a BBS for them to discuss their hobby, now the folks will be typing and clicking.. Give the staff a month or so to get going ..

mantra
"it's not about cutting jobs it's about making your job easier"

All the issues except for capitol are all interelated. Each issue has an dependency, so all needs to be addressed.. The priority is really on a case by case basis.

Lets look at paper office migrating to a paperless office.
lets say a 1 doctor practice
How long ? 6 to 12 months.. is not unreasonable..

day 1 get the network running and internet running have everyone write where they think they will be in 2 months
day 7 typing class running
day 14 mini website running
day 21 Biggest technophobe is in charge of website email.
day 22 send a couple of email to website
day 28 technophobe is empowered with email.
day 28 milestone 1 completed
day 35 start using email for inter office messages / even chat clients instead of phone calls interoffice
day 42 internal calendar for all office functions
day 49 Word template for standard office forms
day 56 XLS template for all patients
day 63 Review the comments from day 1 and show the staff how painless the migration is going and maybe a victory lunch or whatever.

I could go on but it would really depend on the situtation etc..
Should you show this list to the staff ..?? dunno I keep it to myself because otherwise in a bigger environment folks get all over the place and then you spend more time herding cats LOL.
The key is to stay on one timeline at a time and not to move on until that goal is completed. Pair up the staff in teams of two..

oz

[Kursk]

Very practical, good ideas, thanks Oz.

[ozzie]

Want to expand a little ?? not sure what you mean..
oz

Right now I am dealing with typing intense application. Even with autotext, autocomplete, autoformat etc users still are having trouble typing. Workflow/cost/ROI do not allow dictation/VR at this time.

[Kursk]

In order to ease the burden of typing I use Word as a front end. Word offers a familiar interface for most of the staff. Autotext/autocorrect allows user to define custom key strokes that trigger stored text and automatically corrects some defined typing problems. Word acts as the front end to an Access back end. The benefits of Word can be marginal with poor typists. Unfortunately, in Internal Medicine the perplexing complexity of describing symptoms and exams makes checkboxes and templates more difficult to use. Hence the "typing intensity". I have managed to create something that is quite useful and yet at the same time brutally stupid.

[ozzie]

Ok now I can relate to that .. I used to have the same problem writing technical docs..
My solution was simply to add all the tech word etc Like ATM TCP/IP etc to the dictionary, then when done check with the spell checker.. However I did not have the same time problems I would guess as you have in daily practice..
An important point is that technology should always be in addition to rather than in replace of ..
I see many folks are looking for the unltimate software ..
It is not out there and never will be, any software is going to be compromise.
The oh great wise one has got software beat when that satori'cal moment arrives.
A great example is all the network trouble shooting tools out there and in the end ping tracert nbtstat route print arp /g (a) solve 95 % of the probelms. The rest are in the excrement happens department..
Subtitled you make a fool of an engineer but you cannot make an engineer from a fool..
Making software crunch numbers is one thing and producing results from static data to produce acceptable static results is OK too. However the notion of producing artificial intelligence to make medical decsions to me is not so good.
I trust computers to give a logical result. I trust humans to give me a logical variable result, People care computers don't.

oz

[Scroggie]

Kursk, what I use is a combination of free text entry, pick lists and command buttons.
I have a blank text box, and you can type in whatever you want, or use a pick list to combine words/phrases to make a exam/history sentence. or a command button that inserts a full paragraph (picklists are limted to 255 characters). I'd show you if BigDoc ever lets me upload more than 10kb . . .

[ozzie]

email me and I will give you private upload then I will publish it on my website..
wont happen till later on tonight as i am busy right now

oz

[Kursk]

Scroggs/Oz; thanks for the feedback. Spent all weekend getting another MDs puters updated (!@!@#$!@ Dell puts all kinds of crap on these things now) and WPA enabled, VBA dripping out of my ears and I have that glazed stare that comes with hours of debugging.

[ozzie]

Language please Dr..
tisk tisk for a nano second I though you said @$#%^#%
new Dell /ibm /whatever
1. fdisk
2.find latest bios updates and install
3.Burn latest drivers to cd rom
4.Reboot install fav OS
if machine gets funky boot from win98 se boot disk then install

Oz

Scroggs/Oz; thanks for the feedback. Spent all weekend getting another MDs puters updated (!@!@#$!@ Dell puts all kinds of crap on these things now) and WPA enabled, VBA dripping out of my ears and I have that glazed stare that comes with hours of debugging.

[Kursk]

Agree with ground zero approach, but no OS disks (just the recovery discs) so I had to work with what was available, spending a lot of time upgrading XP, etc. Plug and PRAY indeed! What I love is you pay for the computer - and you get spammed before you can even start it up! Then hopefully when you delete Dell's favorite virus software of the week everything still works...

[alborg]

Hi Daren and friends:

Well... I finally made it over here from the defunct POL, and I'm impressed! Lots of folks with an interest in making their own EMRs... no EMR vendors trying to peddle $20000.00 softwares, and worse yet, no physicians actually possibly interested in getting sucked into the hype. Good deal... great to know one and all!

For those of you that don't know me, I'm a techie... I've programmed EMRs since 1990, first through Paradox, then I ported to MS Access. I currently have my own EMR based on Microsoft Access 2000. It pretty much runs my oncology office- chemo orders, patient notes, prescriptions, scheduling, and paper billing. Overall it has about 400 forms/reports. Through automation I've associated it with MS Word. I've also programmed an Access-ODBC linked Satellite Forms Palm program for hospital billing and am working on a mini-Palm based hospital EMR to make hospital visit notes. I soon plan to join my software to Medisoft 9.0 via ODBC so that I could do electronic billing. It works well (fast and stable), even though I have yet to get outside of the Jet 4.0 backend.

It'll take me a while to catch up on the many, many threads here...

Regards,
Al

[kleinbaum20538]

I am impressed/

[BigDoc]

Al & Kleinbaum, welcome to Docsboard :D

[ozzie]

Oh I should have added
latest spyware killer http://www.safer-networking.org/
Antivirus http://www.grisoft.com/us/us_index.php
popup blocker http://www.proxomitron.info/
and latest security updates service patches etc
Silly of me to assume that everyone knows this..
and surge protector , emergency recovery disk.
last but not least burn copies of all the media and keep the originals stashed away.
Oh if installing office copy the complete cd to the hardrive this way when ever you do any updates etc you dont lose your mind looking for a cd that is loaned, thrown out, turned into a ash tray /mini frisbee, chewed by the dog or sitting in a laptop bag locale unknown..



What I love is you pay for the computer - and you get spammed before you can even start it up! Then hopefully when you delete Dell's favorite virus software of the week everything still works...

[Kursk]

Grisoft (AVG) is a gem, seems to work well and is cheap! I have been using Spybot which seems to work well. The office tip is a good one (now why do I have to always do it the hard way?)

[ozzie]

Gr(now why do I have to always do it the hard way?)
Maybe the same reason an MD's hand size means nothing until you are a male over 40 LOL.

Trying to live by my technical edict of " a mistake only retains it's status by being repeated " One tends to find out that 300 meg of hard drive space is not much compared to the potential down time.. Also things change 6 or 7 years ago this would not have been practical due to the limit of hard drive size and available space..
I always start by looking at the worst case scenario then after a while best case becomes a by-product..

[robodoc911]

I have heard that Office XP has a built in voice-activated word processing program. Also I think Apple OS also has voice-activated WP function. Does anyone here have experience with those commercial products? Could they be used to generate an EMR?

[Scroggie]

They could, but the functionility is limited, ie the voice recognition is not as good as say Dragon.

[BigDoc]

Scroggs, what is the minimum CPU speed & RAM to run Dragon VR software?

[Scroggie]

I haven't looked recently, but I would say at least 1 gigahertz and 512 of RAM. THe more ram the better.

[BigDoc]

As the saying goes, you can never have too much RAM, money or ***Thanks Scroggie

[Kursk]

Scansoft forums are really the place to go to get the latest consensus on hardware and software pertaining to Dragon. Lots of posts on best hardware/software integration. Microphone and training are also crucial to success.
Dragon Forum (http://support.lhsl.com/databases/dragon/webdisc.nsf/($All)?OpenView&Count=100)

[mbenjam]

Hi, all. I'm finishing heme-onc fellowship in a few months, and my post-training anxiety is manifesting in the form of writing an EMR. I at least have enough time to work on this now--I don't know how you guys in practice can work on this stuff!

Al--I'd be very interested to see what you've been working on. I think oncology is poorly-served by existing EMR solutions, but an information-rich specialty. Since we don't really have a therapeutic procedure to offer, we need ways to control our information. :D

I'm playing with SOAPware and I'm finding that it does 80% of what I would like it to do. It's not really customizable (either within the program or by hacking the MS-SQL tables), but whaddya want for $300? Support is generally not useful.

The other low-cost EMR out there, Amazing Charts, has a really sexy user interface. It's also not very customizable, and it has a weird way of dealing with meds. Also, since Dr. Bertman must check labs on his patients, how does he record them?

I am also developing a PHP-MySQL-HTML EMR. It's pretty slow going. I'm using Dreamweaver-MX basically as a data-entry form maker for my MySQL database. Dreamweaver is awesome, but web applications have disadvantages for EMRs. Loading a 13,000 item ICD-9 lookup form, for example, is pretty slow. Also, tightening the user logic is pretty boring (i.e., input validation, etc). Finally, I was using Word as the document editor/viewer, but it doesn't play nice when you tell it to load/save documents via FTP.

Anyway, just my two cents. I wouldn't mind the squawking of salesmen if their products really had interesting ideas or agreeable prices...

[Kursk]

Jam man I feel your pain. Not only is the web interface tough on loading large lists and field validation it works as a pretty stupid typewriter. Word is great as a front end if people can type at all, especially using Autotext, autocorrect etc. Data input is a killer. Get a nontech doc involved right away. We tend to forget how far ahead we are from our nontech brethren and the little things (like typing, navigating, mousing) can really challenge docs that just want to get done (no wow that's cool factor). You also will be using the program with a different understanding and expectation/logic than new users. My wife is always able to break my early versions in 7 moves or less. She has no sympathy when I ask "Well why would you do it that why anyhow?", telling me "entropy rules". Good luck. I really don't want to create a complete EMR, don't have the time or skill. I am happy with my brute force VBA approach and wouldn't give up my non-normalized tables if Dr. Codd himself was knocking on my door. I always say "don't let the perfect be the enemy of the good!"

[ozzie]

Loading a 13,000 item ICD-9 lookup form, for example, is pretty slow....
Why not just pull from a query ??


Also, tightening the user logic is pretty boring (i.e., input validation, etc). Finally, I was using Word as the document editor/viewer, but it doesn't play nice when you tell it to load/save documents via FTP....

if using php better off with pdf maybe.. The only downside would be if trying to develop a meta database to search the pdf's .. But having said that, all the data is located in tables it's searchable anyhow.

[BigDoc]

Welcome mbenjam, 'nice to know there is a plenty of geeks in medicine ;)

[alborg]

Hi mbenjam:

Congratulations on finishing up your fellowship! Gosh, I feel sorry for you- getting into oncology AFTER the "gold rush" of the 1980's. Did you know that the this year's tax increase was partly funded by revenue grabbed from the oncology chemo pool? Sucks... oh well... now you know why I spend so much time programming. When the Titanic sinks, I'll have something to fall back on. {G} I got into oncology in the early 1990's and it was still pretty good then, but the HMO worms were starting to kick in. One good point, though, is that although the average physician got a 1.5% increase this year, many of our historically underfunded infusion/push codes were INCREASED finally... by up to 400%, to try to offset the losses from the chemotherapy drug costs.

Anyhow, it would be nice to be able to upload stuff... that would be a real boon to many here! We could interchange ideas and software. If I zip my Access software it'll go down to maybe some 40MB (back end + front end).

>>> Dreamweaver-MX basically as a data-entry form maker for my MySQL database.
Now that's cool! Too much graphics, though, will slow down a software... a well constructed database program with limited graphics like Access, or if you want to steer clear from Microsoft, then something like Filemaker Pro or Paradox for Windows, can be very efficient, especially if you are interested in going wireless in the near future. BTW, eClinical Works also has a "web look/feel" to it; an associate of mine uses it, and all I've seen him use it is for 1 patient so far. His tablet PC simply seems to craw with the current wireless technology.
I have purchased Flash MX, though, so as to add FUN graphics into my program, s.a. an opening screen with a doc coming out, taking off his coat, then blowing up the screen. I can achieve this effect with manipulation of the Office Assistant, but to incorporate the Office Assistant effects into my program when it is run under a "runtime" environment is virtually impossible.
>>> I wouldn't mind the squawking of salesmen if their products really had interesting ideas or agreeable prices...
The only oncology program for sale that I know of goes for about $100,000.00... I guess "agreeable" is in the eyes of the beholder.
Regards,
Al

[BigDoc]

I know I'd promised a download area, but have been innundated with stuff, maybe we should collectively put someting together, I think Scroggs said he has a server Linux with several Gigs, Kursk may too have some space, what do you guys think?

[ozzie]

i got about 20 gigs or so with a 200 gig / month download limit

[Scroggie]

BigDoc, I broke my linux server (don't ask). I will be setting up my new office in a coupla months, and will have some space then (on T1) line.

Oz, you got room for me and Al? My zipped files are small, like 4megabytes. Al's is larger.

[ozzie]

yup email me and I will give you a login..
Also I need some exclaimer etc that this is your work derivitive and what kind of license you give to other's ..
just don't need a ex spouse suing me for distributing warez and like to have stuff like that on file ..
If you make it open source then it does not matter
Going to be busy today so i many not get to it until the wee hours hours..
Finishing off a cool bar code prpject

oz

[BigDoc]

Kursk, Scroggs Oz, Mbenjam & Al, et al how about teaming together to make an access based freeware/shareware product to put the vendors asking for $300,000 for an EMR out of business?
The bulk of physicians paying ridiculous amounts of money for EMR products have got very ltd computer skills, but deep pockets, that in part is what keeps the price of EHRs where they are.
If the primary purpose of the project isn't to make money we can probably take on the EMR industry with a product, which does not necesarily have all the bells & whistles, but is functional
Bigdoc

[Kursk]

BD - there are working EMRs already at low cost - Amazing charts, Comchart etc that while not free certainly not expensive enough to prevent interested physicians from buying and using an EMR. There is also an open source collaberative my macophile friend down the hall keeps reminding me about and VISTA apparently is open domain (although I think it has the MUMPS, which is an older language). I realized early on I could make something that could produce documents and prescriptions but I didn't want to spend years (as AB and others have) porting to new languages, expanding to new devices and then trying to add in coding assistence, multi doc used, multi staff user, PM interfaces, billing, imaging, content, decision support, link to hospital DB, etc. And again, the lack of easily followed standards for medical vocabulary, data exchange, interfaces etc make this a huge job if you want a true "paperless" environment that can be used by anyone. IMHO of course, I bow humbly to those with thinner skulls and less prominent foreheads - Oz, Scroggs, Al et al.

[BigDoc]

I demoed Amazing Charts & I don't know whether I wasn't patient enough with it, have you tried it K, or anyone?
I tried Soapware too, thought it was a good ROI, a lot of physicians are scared of going for the low-end products, I don't know why.
Bigdoc

[BigDoc]

one more post to catch you Kursk

[Scroggie]

SOAPware with MSDE (SQL server lite) is quite stable and good. I didn't like amazing charts because it was not well structured for my style.

At this point, the main reason mine isn't "out there" for opensource (which is probably what I would choose to use) is support. I don't want to be answering questions about references and how to change directories from default.

Hall333 has a copy. Oz will let me post it to his website.

It ain't always pretty, but it works well for me. If you do know how to code/alter code in VBA its very easy to customize. The picklists/buttons are easily edited.

Its designed for rheumatologists, so there are some extras like HAQ forms and joint counts.

Every text box can be entered directly via text or double clicked to bring up picklists.

Just some preemptive strikes for when y'all download.

Hall333 what did you think?

[Kursk]

Scroggs: any problems with MySQL - seems like you had it up and running in no time. Anything to watch out for? variable types? Any SQL peculiarities?

[mbenjam]

:eek: Dreamweaver is just basically a WYSIWYG word-processor for web pages, with the ability to generate PHP code on the fly for database interactivity. So Al, you can choose to put a lot of graphics on your page or not--it's up to you. I think you may be thinking of Flash, which is a separate product from Dreamweaver.

The advantage of using Dreamweaver is that it turns out web pages that interact with databases as quickly as Access turns out forms that interact with databases. It is a visual web form development GUI, kind of like "pages" in Access, but using PHP scripting. You can really use your application from any terminal that supports a web browser, including Palm.

The advantage of using MySQL, of course, is that it's an enterprise-class DBMS. I think it runs stuff like airline websites these days.

The drawback is that HTML can be slow, and I haven't figured out how to cache large data files on the local machine.

I think Kursk's point is well taken -- you probably don't REALLY want to design an EMR. Look at Amazing Charts-- it's really pretty, but it lacks major features. That guy's been working on it for around ten years!

The open source stuff is generally not too good. TKFP is tantalizing, but I cannot get the durn thing to run reliably. To run it, you have to become co-developer, and who wants that? Anybody wanna learn Tcl (that's what he used to write it)? VISTA: anybody wanna learn M?

BigDoc--TKFP is probably the furthest along of the open systems out there. Best bet is to help Alex Caldwell and Co. move it to production-ready status. Look on Sourceforge. Your idea is tempting, but I would disagree on the platform. I think you need a "real" DBMS. Problem is you guys seem to be invested in the VBA/Access architecture already. I think if we each tackle one component of the project, it can work. Communication is key--we would have to be willing to document our work.

I agree that SOAPWare is a pretty decent system. It's not innovative or customizable or anything, but what do you want for $300 or so.

Mike

[mbenjam]

BTW--Thanks for the offer to share your work, Al. I'd be interested to see what you've done. From the Usenet archives, seems like you've been at it for a long time. Thanks for the congrats, too. Hopefully there's still some dough left to go around.

Speaking of extra dough, you guys ever think about hiring a team of programmers in India to implement some ideas? You can get developers for as little as $15/hour over there!

Ozz--thanks for the idea. You're talking about storing each doc as a pdf BLOB? As you say--wouldn't that be hard to search?

[Scroggie]

MySQL took a little futzing, but its running nicely now. Had to use third party GUI's to get the tables how I liked em.
Main points on tables
add timestamp(14) to all the updatable tables
you have to set the primary Key and autoincrement properties again (the fields import, but not the properties)
Relationships (PK and Foreign keys) aren't available in the default MyISAM table type).

Set up your ODBC sources before you get too far along (point in the right direction).

Access queries work fine, but little things like True is 1 in Mysql and -1 in access, so make sure you account for that.

My main frusturation was getting the autoincrements to update properly, but got that fixed.

MySQL is likely going to totally replace the access BE in my next build. (boy that sounds professional)

[BigDoc]

Thanks guys, I didn't know there was an open source out there,
I'll contact the authors to try help promote their efforts too.
Bigdoc

[alborg]

Ben:

>>> Speaking of extra dough, you guys ever think about hiring a team of programmers in India to implement some ideas? You can get developers for as little as $15/hour over there!

Actually, a friend of mine that lives in Panama that had a software company which was working on doing an interface for banks in that country. At first he tried to go with some Russian programmers; he completed a contract and everything seemed to be going well. Once the software was about 80% completed, the programmers, who lacked the American work ethic, broke off and demanded that they get paid 50% of all the profits, or they would disappear. He lost the project. He then tried to go with some Cuban programmers... and ended up bankrupt.

In the past, especially, I was pretty active in the usenet groups. I especially liked to answer difficult questions. I kept an electronic manual of my canned responses which I've posted in my Yahoo download site- http://f1.pg.briefcase.yahoo.com/bc/alborgmd (see "My miscellaneous Access Notes"). There are also numerous other open / closed source forms and reports from my software that I'll be upgrading in the near future. I'll use my associate's DSL line to eventually upload an Installshield *.exe file of my software in the near future.

Regards,
Al

[ozzie]

if you can all wait about a month i will have solution for you all .
but i just need a little time..
i could let the cat out fo the bag but then i will get bogged down in details..
which gets old and don't pay the bills.. and herding cats is not fun..
So just chill and we can play a great system and within a month or so you will be https'ing your brains out..
Everyone can have their own little test area to play and it's fairly easy to tweak.. For the non geeks I am working on a solution for you folks also..
So let focus on details that will make more sense..
i will start a couple of threads and we will go from there..

oz

[mbenjam]

Sounds exciting, Ozzie--we'll be looking forward to hearing more.

Thanks for the warning, Al.

A friend of mine from residency has a dad who runs a school in India. He had offered me programmers at the school for $10/hour. The whole thing was a little half-baked (it's a nursing school, for example), but maybe I should get back in touch with him...

I'm liking SOAPWare more and more--it really has a lot of features. I don't like the stepladder licensing approach--the extra license fees don't really add a lot of extra functionality.

Mike

[ozzie]

Having been on the bad end of few outsourced ( overseas) projects it may be cheaper but also may not be better in the long term..
thera are many issues outsourcing and it's an area I just don't want to go.
I have clients now that outsources simple text manipulation jobs and in the end the cost saving is not that great as all the work needs to be double checked anyhow which is the greater part of this clients job anyhow..
Grunt work is one thing coding specific module is far different ..
php is not dropping and dragging dll's and packaging ..
My myl php coder is a gal who has been coding for years and worked in a hospital so she understands the end result and the code anterior and posterior.
So I would prefer to pay her $50 an hour and get it done once and right than $10 an hour and have to go over it 3 times and the emails etc and costing me $50 anyhow Time is money ..
Aside from all that I prefer to support the american people as they support my family and my families future is important to me to..
Yeah I am one of those that spends in the local store instead of walmart..
It hard to be sypathetic to the third world when your income is being exported out..(grin)
Right now I am working at agency which will by the end of the days give 20,000 pounds of food to about 300 odd families who have been verfiied as on or below the federal poverty level.. Note that verification is done by the agency so we know the folks need the food. This is 50 blocks from midtown manhattan. This process happens every thursday and we do the same but 2/3 of the about every saturday..

So thats why I am a pain when it comes to outsourcing..
Flame me if you will but thats just the way I see it..

[mbenjam]

It's all good. People gotta make a living--even docs and programmers. I'll be looking forward to seeing what you've cooked up--sounds like you know what you're talking about. You might have saved me time and money.
:)

[ozzie]

the stuff on yahoo is all the stuff for your ap ?? and can you put up a time bomb thats like 3 months ahead rather than 4 behind..(grin)
oz

[Kursk]

Question: What's your RX module look like? Trying to do any interactions? Automatic fax to pharmacy? I am having trouble getting a ruling on faxing in this state - need for signature etc, so I am interested in y'alls approach. Also wondering if we should open a thread listing all the functions of our apps so we can learn and share - Multiuser, web base, database engine, remote access, lab connections etc.

[Kursk]

MySQL took a little futzing, but its running nicely now. Had to use third party GUI's to get the tables how I liked em.
Main points on tables
add timestamp(14) to all the updatable tables
you have to set the primary Key and autoincrement properties again (the fields import, but not the properties)
Relationships (PK and Foreign keys) aren't available in the default MyISAM table type).

Set up your ODBC sources before you get too far along (point in the right direction).

Access queries work fine, but little things like True is 1 in Mysql and -1 in access, so make sure you account for that.

My main frusturation was getting the autoincrements to update properly, but got that fixed.

MySQL is likely going to totally replace the access BE in my next build. (boy that sounds professional)
Thanks, useful stuff, appreciate it. Upgraded an app to MSDE yesterday and you saved me some time on that! I used ADP which is a pretty simple conversion. Used SQLOLEDB connection type. All the forms worked fine, just switched DAO to ADO. ADP allows direct visualization and manipulation of tables just like access except the field types are different. Gonna give .net another go soon as I get some more time and will use MySQL for that.

[ozzie]

It could be easily argued that phone and fax are one of the same. And fax is more secure as you can verify the source easily. You can sign the script with an image signature as long as you have logging then you can prove it was you logged in.. maybe make one phone a call at the ned of the day to give a run down of all the scripts called in..
Hi this is the iron monkey I faxed 20 scripts today is that what you have ??
yes Ok cool CYA.

I want to takes the scripts to a higher level. Email the pdf's then the auto return reply takes care of the reciept part. and the pahrmacy has to cut and paste the vitals of the script back to you . so not only you kno the script got ther but also you know the right informations was read.. Also email the the known intereactions which you would give to your patient. Many pharmacies have software that does all this so why not leverage it ..
Also I would give the patients a ID card with a bar code deal so the patient can go to the pharmacy ahead of the line swipe in and sign pay and be off.
Great free ad at the local pharma when your patients get to jump the line. Also the pharma will play the game as it's biz for them too.. By the time the patient gets to the pharma the script has been pulled.
Sybotic relationships with pharma make sense the small pharma is going to be the service based the big pharma is going to be profit based..

Question: What's your RX module look like? Trying to do any interactions? Automatic fax to pharmacy? I am having trouble getting a ruling on faxing in this state - need for signature etc, so I am interested in y'alls approach. Also wondering if we should open a thread listing all the functions of our apps so we can learn and share - Multiuser, web base, database engine, remote access, lab connections etc.

[Kursk]

Oz - isn't there some collaberative effort on the pharm side to establish secure pharm messaging (with a business model we have to pay for of course!)? This is one:
http://www.surescripts.com/getconnected/

[ozzie]

I prefer to see a local doc deal with a local pharma .. the big chains take all the fun out of it and also end up with too much control . let the chains and HMO all screw each other and deal with the problems . I believe there is enough market place to allow service and quality to be an arbiter. Also the smaller towns dont have the chains and HMO's ..
The system I am taking about would cost the pharma maybe $300 to deploy and the Dr may $50 <-- for the mini ad in the pharma.. Maybe the pharma will pay the production cost of the cards if their info is on the back ??
The Dr cost for hardware for the cards is about $600 one time and $100 per scanner location (for the scanner)
the ID cards provide a platform for a community tool also . The bonding of the patient to the doctor. I use the term ID but really the info is very inert on the card because of security etc .. just has the persons name and a number and the Dr contact info on one side and on the other maybe the pharma stuff or could have donor info med alerts whatever..
The system i see is very basic but effective ..any time new patient is added an updated spreadsheet is emailed to the pharma which has patient name and unique ID..
Its not that hard to have the card on the pahrma end interact with their their Db/ system cost maybe $500 to set up one time .. depending on how $hitty their gui is.. I say that because many front ends are very sloppy code wise..

oz



Oz - isn't there some collaberative effort on the pharm side to establish secure pharm messaging (with a business model we have to pay for of course!)? This is one:
http://www.surescripts.com/getconnected/

[BigDoc]

K, AdvancePCS (http://www.advancepcs.com/) have something similar, is free & has formularly info as well as patient prescription history (assuming px uses only that pharmacy :rolleyes: ), 'not ready for prime time, but I think looks promising. Many pharmacies now have the ability to receive electronic prescriptions.
Bigdoc

[alborg]

Hi ozzie:

I'll be upgrading the stuff on my download site in the next 2 weeks as fast as I can; I have to admit that most of the files are about 2 years old! The documentation files are good, though. It's my program that need upgrading; at first I didn't know about what you meant about the "timebomb" feature of my then-app... actually, it blew up one day on a Monday nevertheless, just before patient care. I had to upgrade my software not only for my office but also for the few docs using it in theirs! I usually put this date years ahead of time; I had forgotten about it.

Regards,
Al

[mbenjam]

Looking forward to it, Al.

[ozzie]

Hi ozzie:

I'll be upgrading the stuff on my download site in the next 2 weeks as fast as I can; I have to admit that most of the files are about 2 years old! The documentation files are good, though. It's my program that need upgrading; at first I didn't know about what you meant about the "timebomb" feature of my then-app... actually, it blew up one day on a Monday nevertheless, just before patient care. I had to upgrade my software not only for my office but also for the few docs using it in theirs! I usually put this date years ahead of time; I had forgotten about it.

Regards,
Al
if its open source why time bomb in the first place ???

[ozzie]

K, AdvancePCS (http://www.advancepcs.com/) have something similar, is free & has formularly info as well as patient prescription history (assuming px uses only that pharmacy :rolleyes: ), 'not ready for prime time, but I think looks promising. Many pharmacies now have the ability to receive electronic prescriptions.
Bigdoc
its the right idea but in the end will not be for free..
This is really a national or even global solution.. I look for local concepts and thats where my thinking is locally. Outside the VA most Dr's are local ..

oz

[alborg]

>>> if its open source why time bomb in the first place ???

It's a hugh database that one day I may need to live off of... what I did, though, was to break off certain sections to explain "how to do" certain coding tricks that I've picked up over 14 years of coding. For now, I see the following open source segments: lab and scheduler. I'll add more as needed...

I think that I've also uploaded 2 small databases that focus on difficult to perform tricks in MS Access (these written by someone else)... very well done, indeed. In my upgrade of my site I will also upload the original open source version of "Checkwriter" that formed the backbone of my original EMR.

Regards,
Al


Regards,
Al

[ozzie]

In the interest of truth justice and the comics you should disclose this.. Would not be nice getting a lawsuit from a locked out Dr. who thought it was free from day one..
If thats the case call it shareware and define the time limitations.. You can always give away shareware as beta dev mode and once in production mode charge.. Does not stop you from giving the beta dev users a free license.
But be advised there is NO money in selling software.. The money is in MAINTAINING software.

The more I see and hear Dr are crying out for solutions, the few ubergeek Dr do not make the majority..

In the interests of disclosure I am NOT an access fan.. Only the human race has more variants than access and the same amount of flaws ROFL

oz


>>> if its open source why time bomb in the first place ???

It's a hugh database that one day I may need to live off of... what I did, though, was to break off certain sections to explain "how to do" certain coding tricks that I've picked up over 14 years of coding. For now, I see the following open source segments: lab and scheduler. I'll add more as needed...

I think that I've also uploaded 2 small databases that focus on difficult to perform tricks in MS Access (these written by someone else)... very well done, indeed. In my upgrade of my site I will also upload the original open source version of "Checkwriter" that formed the backbone of my original EMR.

Regards,
Al


Regards,
Al

[alborg]

Hi ozzie:

>>> In the interest of truth justice and the comics you should disclose this.. Would not be nice getting a lawsuit from a locked out Dr. who thought it was free from day one..

Actually, the terms are on the splashscreen... this is freeware for now, but if one day I would like to sell it, then I want to keep my options open. Upgrades to my software are available at any time to those that already have it.

If my software gets lost, stolen, or lands in the wrong hands at any time, I would for now to lock out the user. At any time, though, the backend would be open to the user to transfer the MS Access files in case they would like to port their files to another platform. If I retire and do put my software up for sales, the lockout would disappear.

>>> The money is in MAINTAINING software.

True... that's the one statement that I tried to come across to the greater-than-$12000.00 vendors while posting in POL. Some vendors, though, are now going to the subscription route; it seems to be working, as it's catching on with a lot of EMR's out there. Maintenance would be included in that price. Microsoft is trying to go that route too...

>>> Does not stop you from giving the beta dev users a free license.

One option would be the "activation" route a la Microsoft. As much as I hated it when implemented with MS Office XP, with niche products, it could be an ideal solution.

Regards,
Al

[ozzie]

snip
One option would be the "activation" route a la Microsoft. As much as I hated it when implemented with MS Office XP, with niche products, it could be an ideal solution.
snip
the best solution is dongles but they cost about $20 per PC no dongle no work. Software keys get broken by software.. hardware keys get broken by hammers LOL
The maintainence idea works but many vendors are charging too much for too little. Now they charge for bug and security patches via subscription . which was normally free and if you wanted the new functionality you paid for the upgrade/. Now vendors charge for support subscription which means access to a web site and free upgrades and include bug fixes.. Sneaky SOB's

[Kursk]

broadcast

sometimes I try to be a better coder and such and clean up some old (bad) code. Since I don't sell this stuff (as if) I find that error control isn't that useful to me or those close by. It's better to get the application error that gives a debug option that then takes you directly to the offensive line. Although the error control lines are in the app I usually set a global variable (ie If conDebug = false then on error goto ....) that I use to turn them off. Jus wonderin' what 'chall do. Maybe I am lazy ... ok I am lazy ...

[Scroggie]

K-man, I may be just a cave man coder, I don't understand your error trapping.

I'm with you, just give the debugger and I'll fix it. After this long, I don't have to do that more than once a day.

[jlively]

For error handling I build a class that will accept the exception source, exception message, the sub where the error occured, stack trace, variable values for that sub, time date stamp, user name, SQL string if there was one and write it to a text file. Depending on a system wide setting I open a message box allowing the user to send me the text file. If they select to send I also capture a screen shot and send both back to me. I consider bugs in my programs to be personal failures and make every effort to ensure they never happen, if they do happen I go to great lengths to make sure I can fix them. Without this info you may never be able to recreate the error and find the bug.

[Kursk]

jlively - nice, professional. You have however stepped into a dark bar down by the docks, and them penny loafers don't look right.

We be talking cave man code here, stone tools, bits o twine.

Your light is too bright and we run in fear .....

Scroggs - (tribe brother)

you know - the error code Access creates when you let the wizard thing do that thing (codes a button for you on the form) and ya know, it creates that c0de stuff?

on error goto YourButton_Click_Error
'my primative code
if strTalk = "ugh" then msgbox "me Kursk"
YourButton_Click_Exit:
exit sub
YourButton_Click_Error:
msgbox "kursk stupid again" & err.number, "Caveman Code Hurt"
resume YourButton_Click_Exit

[Scroggie]

Most of good code ritten before wizard and his magics. Too much semicolons hurt. I no trust the wizard and scratch my code out myself.

[Kursk]

Jlively:
If I am following you (wild guess here that you are a C guy, so dumb it down for us VB troglodytes):
stack = structure with event handler names (error object in VB does not have a event name property so this must be written into the error handler) with latest executed event on the top of the stack. Unless you are referring to an API function, don't think VBA/VB has this object.

"You may also want to consider creating a procedure stack. A stack is simply a list of procedures, and the order they are executing in. This list is useful when your application encounters an unanticipated error. When such an error occurs, you can inspect the procedure stack, and see exactly which procedures were executing, and in which order. A stack is typically implemented with an array. Initialize the array when your application starts. Then, at the beginning of each procedure, place the procedure’s name as the last element of the array, moving all other array elements up by one. Just before the procedure exits, it should remove its name from the array. Although this approach requires extra coding effort, it can be well worth it when trying to debug applications when the application and user are at a remote site"
From: http://www.fmsinc.com/tpapers/vbacode/index.html#8:%20Implement%20Robust%20Error%20Handl ing

To get the SQL strings in DAO need to assign them to a string variable or use ADO - command object

How are you doing the messaging from a remote site?

Thanks for the tips. I can feel one of my gyri near the sylvian fissure trying to reform. OWWW it hurts!!!!!

[jlively]

Actually my comment was for vb.net not c. I find RAD (VB and VB.net) to suite me better than all the tough coding of C. Error hadling is the same concept though. Here is some code that is from Access VBA that you could use for a simple error handling. Not too difficult.


Private Sub mainsub()
On Error GoTo err_rpt

' Enter module source here

no_err:
Exit Sub

err_rpt:
' send errors to logfile

Call errhandler("mainsub", Err.Number, Err.Source, Err.Description)

Resume no_err
End Sub



Public Function errhandler(errmod As String, errnum As String, errsource As String, errdesc As String)

Const LogFileName As String = "C:\FOLDERNAME\TEXTFILE.LOG" ' change this to your file name
Dim FileNum As Integer

On Error Resume Next ' dont allow an error in your error handler to break execution


FileNum = FreeFile ' next file number
Open LogFileName For Append As #FileNum ' appends or creates the file if it doesn't exist
Print #FileNum, "****************************************"
Print #FileNum, "Date / Time - " & Now()
Print #FileNum, "Module - " & errmod
Print #FileNum, "Error Number - " & errnum
Print #FileNum, "Error Source - " & errsource
Print #FileNum, "Error Desc - " & errdesc

Close #FileNum ' close the file

End Function

[Kursk]

Thanks, J. Very clean. I can dig it.
Just starting some .net stuff again -
How does it change in .net?