Want to save a bundle of money in your practice? Heres a simple suggestion: buy your own computers. Too often, practices are sold bundled systems, ones that include both software applications...
Want to save a bundle of money in your practice? Here’s a simple suggestion: buy your own computers. Too often, practices are sold bundled systems, ones that include both software applications and hardware. These systems typically have much more technology than you need, at some bloated price you probably can’t afford. I’ve met doctors at conferences who are still paying off computer systems they purchased years ago at outrageously inflated prices.
The truth is that most small practices (fewer than four doctors) don’t need any special hardware to run affordable healthcare applications such as electronic health records (EHR) and practice management software. Any current, off-the-shelf computer from a local store or online retailer will be more than adequate.
The real problem is that most physicians are intimidated by the process of buying computers on their own. For many of us, the number one worry is that we will buy the wrong computer—one that won’t be able to do what we need it to do. Others are not sure where or how to purchase a computer, given the wide range of choices—superstore, specialty retailer, catalogue, or Internet. The good news is that if you got through medical school and residency, you damn well can purchase your own computer and save a lot of money in the process. Actually, you don’t have to be well educated or indoctrinated to get a great computer: luckily, it is really hard to go wrong. Computers today are so powerful and so affordable that the only way you will screw up is by signing some contract requiring you to lease or buy this hardware through a third-party vendor.
The Computer: Desktop vs. Laptop vs. Tablet
That brings us to the first big decision: desktop versus laptop versus tablet (versus PDA). Of course, there are plusses and minuses for each—deciding what you’ll primarily be using the computer to do should dictate the type you choose.
Desktops are immobile; once you set one up in your office, it’s not going anywhere easily. In general, any off-the-shelf desktop will be powerful, fast, and have plenty of memory. Desktops often come with a nice big monitor that is easy to read, a normal-sized keyboard, and a relatively inexpensive price tag. Clearly, if you do most of your work at your desk, a desktop computer is for you.
Laptop computers, on the other hand, are highly portable and usually have built-in wireless capability, so you can take them from exam room to exam room while still connecting to a wireless network. They are also good for use in small rooms where desk space is at a premium. Laptops have most of the power and ability of the desktops; but keep in mind that their compact components, including screens and keyboards, not only make them more expensive than their desktop counterparts, but make them somewhat more difficult to use. Laptops come in all shapes and sizes (and weights), so if your goal is to be mobile, you’ll want to go with a smaller, lighter one.
The third option being pushed by many EHR vendors is the tablet PC. These devices are usually smaller and lighter than traditional laptop computers. They mimic a paper chart in size and even allow you to write directly onto the screen with a stylus. Your scrawl is captured as “digital ink” and can be saved or converted (fairly well) to typewritten text. Yet tablet PCs are still significantly overpriced and underpowered compared to their laptop cousins. And while they are touted as fitting painlessly into the usual busy flow of a doc moving room to room, when you accidentally drop it off the edge of the table, “painless” won’t be the word that comes to mind.
Today’s Personal Digital Assistant, or PDA, can’t replace the computers discussed above. They are great for holding reference material and have some cool tools available, but they are not suitable for standard office work—including EHR documentation—since they have very small screens and short battery life. Input options are limited to a stylus or tiny keyboards usually meant for thumb typing. PDAs are ideal only as an adjunct to your main computer, not as a replacement.
The Operating System: Windows vs. Macintosh vs. Linux
The operating system (OS) is the software that controls the computer and allows it to run various software packages including word processing, spreadsheets, and EHRs. By far, the most well-known is Microsoft’s Windows (eg, Windows XP), with Apple’s Macintosh (eg, OS X) and Linux (eg, Redhat) fighting for second and third place. Windows, though, is the operating system in more than 95% of computers, and while Linux is more affordable and the code is non-proprietary (open source) and Apple tends to be more user-friendly and aesthetically pleasing to use, Windows is, by far, the market leader with much more available software and hardware. In fact, if you are going to use your practice computers to run an EHR, your choice of operating system has already been decided for you, as most healthcare software is designed to run on Windows. You won’t go wrong with Windows XP (I recommend XP Professional edition for your business).
Display monitors range from 15-inch Cathode Ray Tubes (CRTs) that sell for under $100 to feet-wide flat-screen Liquid Crystal Displays (LCDs) that sell for well over $1,000. If you have plenty of desk space, a CRT will save you lots of money, but they are so heavy and bulky that I personally believe it’s better to splurge on a flat screen. It does not really matter which brand or size you get, but going for a 17” or larger LCD is definitely worth it, as it will reduce eye strain, make it easer to view images, and give you plenty of room to move documents about on the screen.
Details: Don’t Sweat the Specs
Once you’ve picked a brand and you know where to buy it, the rest is easy. That’s because virtually any Microsoft Windows-based computer on the market will satisfy your needs. In terms of specs, there are a few basic requirements, but most systems priced around $500 will satisfy these needs.
Unless you’re buying a Mac, any new computer you buy will likely come with the Microsoft Windows XP Professional or Home Edition operating system pre-installed and ready to go. To run this operating system, a computer must meet certain minimum requirements, including sufficient Central Processing Unit (CPU) performance, Random Access Memory (RAM) size, and Hard Disk Drive (HDD) space. As long as the system runs Windows XP, you really don’t need to worry about the rest of the specs. It will have more than enough speed and memory to run most software packages. That said, one thing to keep in mind is that if you plan on using speech recognition software like Dragon Naturally Speaking, you’ll want to splurge on RAM. Other than your wallet, it never hurts to upgrade to more RAM.
The Windows XP operating system includes the Internet Explorer browser, which will let you get online and visit websites. It will also include some basic free applications for doing things like playing music or viewing photos. Some applications like Microsoft Office—a suite that includes the popular Word, Excel, and Outlook—will cost a few hundred dollars extra, but are well worth getting at the time you purchase the system, because they will cost more if purchased separately and come pre-installed, saving you time and energy.
Finally, don’t be fooled by the kinds of gimmicks that you wouldn’t accept from a car salesman. For example, extended warranties are never worthwhile, especially for a computer. Due to the constant evolution of technology and falling prices, the shelf life of a computer is typically less than five years. Most components will last that long, with the possible exception of a hard drive, which is more prone to failure. The answer, though, is not an extended warranty, but rather being in the habit of backing up your data regularly (a topic of a future column).
Once you get your computer, it will be relatively easy to set up. Computers today come with color-coded cables and quick-start, step-by-step guides that should have you up and running in less than 15 minutes. Networking computers together, while not difficult, is a subject big enough for another column.
Hopefully by now you realize that buying a computer could not be easier. First, pick whether you want a desktop or laptop, and then decide on your operating system. For most of us, XP Pro is the correct choice. Most systems priced around $500 will satisfy 99% of your needs. A nice-sized flat-screen monitor and pre-installed Microsoft Office (Small Business edition) are well worth the added price. Finally, choose whom you wish to buy your computer from—my vote is through an established online company like Dell or Gateway.
In addition to serving as Physician Editor-in-Chief of MD Net Guide, Dr. Bertman is a Clinical Assistant Professor of Family Medicine at Brown University, and the founder and president of Amazing Charts (Electronic Health Records). He is in private practice in Hope Valley, RI. He can be reached at email@example.com.
The Store: Where to Buy Your Computer
If you prefer immediate gratification and want a computer today, you’ll want to buy it at a bricks-and-mortar retailer such as a computer or electronics superstore. If you are comfortable buying a product without touching it or going home with it on the same day, then save yourself a trip to the local shopping center and use the Internet or a catalogue to purchase your equipment; you will avoid the hard-sell tactics of the superstore and likely pay less than you would at a store.
Personally, I like the Dell website because it’s fast, easy to use, and lets you pick and choose the options you want. This is not a recommendation for the Dell brand; I don’t believe that a system from Dell is really any different than one from Gateway, Sony, or any other major vendor. They are all essentially the same inside, so you should go with a brand name you trust and one that has good customer satisfaction. Historically, Dell was the leader here, though recently Apple has taken over first place. Before buying a new computer, I review PC World magazine. This and other technology magazines actually test computers and rank them on a number of criteria, including price, functionality, speed, and customer support. If you pick one of the computers that make PC World’s Top Ten, you’ll be in good shape.