Computers in Family Practice

Editor: Roger A. Rosenblatt, MD, MPH

The Computer for Practice Management: Part 2. Software, Hardware, and Aftermarket Services

Matthew Cushing, Jr, MD Andover, Massachusetts

il field? Second, is it possible to get the names of In the preceding issue, Dr. Cushing introduced the e primary care people with whom he has dealt? importance o f system goals and design, hardware, enerally speaking, the broader the range of hard- elements of the system, and software elements. are brands offered, the wider the choice of soft- In Part 2, Dr. Cushing covers how to search for are available. One-brand stores have a limited the right software, how to fit the hardware to the ilection and probably should not be consulted software, and aftermarket services.—Roger A. itially. It is also wise to avoid mail-order prod- Rosenblatt, Editor ;ts entirely. These products are less expensive, at the headache factor in trying to deal with prob­ e s and questions at long distance more than jmpensates for any savings. Delays of three to How to Find the Right Software ve months are not unknown in response to letters f inquiry to major and reputable hardware and Finding the right software dealer may be the jftware manufacturers. Avoid also the ‘‘supei- hardest part of the whole process. Advertising is larket” stores, which thrive on volume and quick of little use, other than to make buyers aware of rmover and are not equipped, either in personne the existence of an outlet and what brands of r attitude, for hand-holding. , hardware it handles. Most dealers advertise ma­ The following are five rules to follow when de- chines, not software, and untrained and naive iding which software to purchase: buyers respond to this merchandising approach. Rule 1: Never buy any software until all the First, test the knowledgeability of the salesperson. equipments for the system design have been iden- Does he know accounting, and can he direct you ified and listed, including number of users, nu to more than one package, especially in the medi- ier of terminals, backup requirements, and so on. Rule 2- If a fully designed software package is ,eta considered, take home the manna of m- .(ructions (documentation) and read >t ‘h ™ * Requests for reprints should be addressed to Dr. Matthew hen give it to the bookkeeper to read. If anyone Cushing, Jr, 140 Haverhill Street, Andover, MA 018 iu. e -|983 Appleton-Century-Crofts

NO. 6: 1087-1089, 1983 THE JOURNAL OF FAMILY PRACTICE, VOL. 17, COMPUTER FOR PRACTICE MANAGEMENT

has trouble understanding it, return it and try an­ a medical office. Before engaging a consultant other package. determine how much knowledge and experience Rule 3: If the manual is understandable, have he or she has had in running medical practice sys­ the salesman run the program on his machine. Be tems, and, of course, check references. A few sure to allow at least 90 minutes for this. Go questions to test the consultant are (1) does the through dummy data entries several times. Make system handle piggyback payments to third par­ frequent deliberate mistakes, especially hitting the ties, (2) how does it deal with coordination of wrong keys (like “ ctrl” instead of “ return,” and benefits, and (3) can it tell the difference between “ esc” and “break” instead of alphabetic-numeric concomitant and concurrent care? keys) to see whether the program can be made to If the consultant cannot respond intelligently to crash. If it can crash accidentally, do not buy it. If two or three of these questions, find another con­ the program does not crash, then be sure that it is sultant. If a consultant will not be used, be pre­ possible to change fees, procedure codes, and pared to spend the equivalent of an eight-hour day, diagnosis codes during data entry, that lists of excluding travel time, in making a decision. these codes can be called up on the screen without Be particularly wary of the company that will having to look them up in a book, and that data sell an integrated package but does not know or entry mistakes can be corrected, even after the will not say who made the hardware, what lan­ “ return” key has been pressed. Also ensure that guage and operating system are used, whether the all lists can be displayed on the screen as well as dealer has access to the source code (the original, on a printout. Inability to print all lists and tables English-like instructions to the machine) for the on the screen is a common problem. Finally, any purpose of custom modifications, or whether the “error” messages must be easily understood—no machine and code are modular. “ error PC at line 1256” nonsense. Remember, also, that vendor lifetimes in the Rule 4: Determine what operating system (the com puter business are distressingly brief. An software that interfaces the program with the obscure company may turn into another IBM, but hardware) the package under consideration uses. there is a significant risk of its never being heard It should be a common one so that it will be possi­ from again, which would leave the buyer with a ble to obtain the names of at least five users of that dead-end system. package from the dealer. The following are some Now, a word about word processors. A word common operating systems: CP/M, MP/M, MS- processor is a program that accepts typed text DOS, PC/DOS, APPLEDOS, TRSDOS, NEW- input and allows manipulation of the text in an DOS, LDOS, UNIX, TURBODOS, DOSPLUS, area of memory (RAM) before il is stored on non­ and RT11. volatile memory (disks) or printed. This manipu­ Rule 5: After the right software package has lation consists of additions, deletions, and trans­ been found to fit the needs of the practice, get the position of letters, words, phrases, and paragraphs names of at least five users of that package from until the author is satisfied with the construction of the dealer. Call the users to determine whether all the text. Most programs are very versatile, allow­ are satisfied with the product and its support. ing changing of the margins and page format (how Make sure they have been putting it to practical the printed text appears), automatic headings and use for a minimum of several months. List their page numbering, searching and changing similar complaints, if any (there should be complaints text throughout a document, and many other fea­ with every product), and return to the dealer with tures. Such programs can make typing a report a these comments to see (1) whether the author of pleasure. Further, some programs will allow in­ the program is aware of the problems, and (2) if so, sertion of variables from other files to create form whether he is writing an update or “ fix” for them. letters (MailMerge, for example). If the author is not aware of them, be sure he is If the only text typing done in the office is made so. three-line progress notes and an occasional letter, If the footwork thus far seems too much, it is it is not necessary to have a word processor. If a possible to pay a consultant to find and install a secretary does all the typing, is a confirmed com- system. Most are reasonably proficient in comput­ puterphobe, and likes her IBM Selectric, a word ers, but can be ignorant of the realities of running processor is not necessary. If most of what is sent

1088 THE JOURNAL OF FAMILY PRACTICE, VOL. 17, NO. 6, 1983 COMPUTER FOR PRACTICE MANAGEMENT out is “boilerplate” (repetitive paragraphs, such ware to the software and operating system, look at as x-ray reports) that needs at most minor revision the added features on the hardware, the thing that for the case at hand, if a large amount of original neophytes look at first. Good fringe benefits would writing is done in the practice, and if the computer be several user-programmable function keys (spe­ will be used to print out order sheets for the hospi­ cial keys that can be taught to mean special com­ tal or instruction sheets for patients, a word proc­ mands to save time), separate keypad for quick essor would be indicated. number entry, nonglare and tillable screen, The best known leading word processor pro­ keys with positive-action click (sometimes audi­ gram, WordStar, is relatively complete and un­ ble) and comfortable feel to the fingers, and “ ar­ usually versatile. WordStar uses menus printed at row keys ' to move the cursor (the flashing line or the top of each page to remind the operator of the dot that tells you where you are typing on the commands available, it is rather complex, and the screen) around the screen for data entry (some commands are hard to remember because they are machines have gimmicks, such as a “ mouse,” two to three letters long and are not necessarily which is a little box on wheels that you roll around mnemonic (for example, “ c trl” plus “ d” is the on the table, controlling the cursor). At the least command for “ move cursor right one character” ). the keyboard should allow upper and lower case, Other programs combine versatility with com­ all the punctuation marks, including bracket, mands that are easier to understand. If a word brace, backslash, carat, tilde, underline, a key processor is being considered, first be sure it will labeled “ ctrl,” one labeled “ esc,” and all the run on the operating system chosen, then sit down digits. and try it out.

Aftermarket Services How to Find the Hardware to Fit A salesman is easy to find when he wants to sell The selection of software and an operating sys­ his equipment and is hard to find when a problem tem limits the buyer to a fairly small number surfaces after the sale is closed. If there is a of computers. For example, if the software runs “ glitch,” an incomprehensible instruction, a con­ under LDOS, it must be run on a Radio Shack, an fusing error message, or an unpredictable result LNW, or a similar computer. If the software runs during data entry or retrieval, it is essential to have under PC/DOS, the buyer is limited to IBM and someone committed to good follow-up service. IBM-compatible machines. Within the area of The liaison person must be reliable. To determine choice, choose hardware based upon the following whether this person is honorable and will remain criteria: available, ask for references from clients to whom Rule 1: A machine that is modular (has plug-in the salesman sold equipment more than six circuit boards) is preferable to one that is not (is months ago. Does the salesman return calls promptly? If he cannot answer a question, does he “hard-wired” ). Rule 2: Never buy a machine that must be re­ get the answer, or refer you to the library ? Will he paired at a facility more than one hour away. Be refer the buyer to experts if the machine has a sure that the service facility will guarantee a rea­ problem he cannot solve? Will he promptly and cheerfully replace defective parts and software? sonable turnaround time. (Machines can be in the The salesman should make arrangements for repair shop for months.) If they have loaners, so training the office staff, either in person or by much the better. audiovisual aids. Ensure that this service is in­ Rule 3: A contract for service after the warranty cluded in the purchase agreement. expires will get faster and more dependable serv­ In summary, a computer is a marvelous techni­ ice. Typical costs are 15 percent of the purchase cal advance and can be great fun to use, as well as price per year. The contract should specify turn­ useful and time-saving, but there are many pitfalls around time on repairs (ie, two business days at to avoid in buying one. The above comments the most). should help any buyer in making the right choices. After satisfying those rules and fitting the hard­

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