Computer Support Network

A strange thing happened on the way to Electronic Medical Health Records and Information Technology.

I have owned and operated an IT consulting company in New York City, for over 25 years. We have three practice areas: government, Fortune companies and small/medium businesses (SMB). Typically there are three types of clients: early adopters, guidance clients and commodity clients. Early adopters recognize the value of technology and are willing to spend more and put up with aggravation in order to gain the benefits of having the technology early on. Early adopters value time and competitive advantage over a dollar spent, as they get more dollars and more time by adopting technologies early in the curve. Guidance clients recognize the value of technology, but don’t want to do the technology themselves. Both early adopters and guidance clients recognize and need quality professional support for the technology that supports their business.

Normal trends show that Fortune companies are early adopters and are willing to spend the time and resources on the “bleeding edge” of technology. Traditionally, we have taken the knowledge learned from the early adopters and spun it out to the guidance clients at a far reduced price and with much less pain. We noticed a new trend in the past year. We have small businesses, specifically doctors, who are playing the part of early adopter. The issue that is new is that they don’t realize they are early adopters. We have found ourselves in a position where we are supporting doctors’ offices that are pushing the envelope forward on technology integration and EMR. Since many doctors are not aware they are early adopters, they expect components that they choose based on what they are attracted to in the marketplace to work, and the task of integrating disparate systems falls on us.

This push is driven harder by the HITECH Medicare EHR incentive program. We noticed certain recurring issues among various doctor/clients of ours going to EHR.

Power/Cooling/Backup/Antivirus/Patching/Upgrades/Physical Space come into play regardless of the EHR software utilized or the office. Also many doctors have multiple offices, and many offices have multiple doctors. The benefits of EHR exist in addition to the HITECH incentives. Fewer staff to do billing, 85-97 percent first time claim reimbursements, electronic payments.

As you might expect, we end up gaining respect and exchanging ideas with the doctors and staff we work with so cooperatively. After a year of solving integration issues with multiple doctors in multiple offices using a wide variety of EHR software and hardware platforms led to a discussion with a doctor who I now consider a friend. Looking at the expense of hardware/software/support I said,
“with the equipment you have for two doctors, we could support 200.” That got me thinking.

If the government thinks the Hardware / Software / Support can be done for 18k per doctor, my company should be able to provide the entire system to a doctor’s office within the reimbursement available from HITECH. We have multiple prototype systems in operational production now that were assembled by the doctors. If we added our expertise early in the design, we could assemble a package that would be simple, reliable and after the HITECH reimbursement, free.
MASS CONFUSION in the marketplace.

There are a number of ways a doctor’s office can implement EMR. If you implement a ‘cloud-based’ system, you can have the equipment in house: thin clients, PC’s, etc… But with our goal of providing a reliable easy-to-work business model based on our experience with the early adopters, how do we provide a highly reliable, fully supported, commercial quality EMR to physicians and make it come in at or under the HITECH incentive?

One thing all of the EMR software providers have in common is that they sell you a cloud, or sell you a piece of software and hand you a piece of paper that is your responsibility. Our goal was to take all of the responsibility for the technology and bureaucracy and just do it for the doctor as part of the package. Our goal is that the doctor should only be concerned with practicing medicine and reaching the target of ‘meaningful compliance’ put forth in HITECH necessary to receive the reimbursement. ITCSNY is responsible for integration of the technology, bureaucratic HITECH paperwork, reliable operation and providing assistance to the doctor to choose the EMR package best suited to his/her practice.

As a result ITCSNY has developed a ‘cooperative’ technology, where the physician joins our EMR co-op and pays a monthly maintenance fee, much like a cooperative apartment. The physician shares the technology with others, but has his own private ‘apartment’ within the co-op. ITCSNY is the “super” and takes care of all of the essential functions such as backup, HIPAA compliance, updates, upgrades, patching, Anti-virus, Anti spam, etc…. There are no additional charges or technical responsibilities for the doctor. ITCSNY has also developed a ‘thin client’ office package, so that offices can be set up with the necessary equipment. All equipment that is fully supported by ITCSNY inclusively is new. We only use commercial quality HIPAA compliant equipment and services.

In summary :

• a. Pay the monthly maintenance.
  b. Achieve meaningful compliance.
  c. Pay the broadband bill (internet access) from each office.
  d. Deposit the reimbursement check from the government.

1. ITCSNY acts as an Independent consultant to assist the doctor to choose which EMR software package to utilize. Since we work with so many, we are in a unique position to provide great advice.
2. ITCSNY provides all the equipment, software and integration services and support, inclusive.
3. If something breaks, we replace it with a new piece.
4. Doctor’s responsibility:

By the way, my early adopter doctor friend called me last week and reported he got his check!

- Dan Scolnick
IT Computer Support of New York
President and Chief Technical Officer

Change is good.  We hear it all the time but when it comes to software I wish someone would step up and say that just because something is new doesn’t mean better.   Now I’m all for security and functionality improvements but the trend in the software industry has been to “modernize” the look of user interfaces.  Almost without exception the reception of these changes has been negative.

Perhaps the biggest offender in recent years has been Microsoft.  Back in 2007 Microsoft released Vista, an operating system that tried to solve the security problems of its predecessor, streamline the user interface and seemingly above all, to be prettier.  Of course we all know Vista was panned by critics and users alike (if a bit harshly in my opinion) and everyone waited for the next iteration.  But instead of Windows 7 let’s look at another product from the same launch period.  MS Office 2007 started a visual trend which sadly plagues all Microsoft products to this day.  Office 2007 introduced the “ribbon” menu, an obtrusive blocky mass of buttons and text that was to replace the traditional menu.  When first released I fondly remember many of my colleagues calling Word 2007, “Baby’s First Word Processor”; a name I remember every time I look up at my menu while writing now.  What made the visual revision so bad though wasn’t that it was ugly but that it was unnecessary and actually removed easy access to functionality that users had used for years.  While the features weren’t completely gone they had been buried under numerous menus and/or now required alternate activation settings.  For most users the changes to the Microsoft Office Suite are the most prominent negative changes but there are examples everywhere.

For about the last year Facebook has been reinventing itself in an effort to stay on top of the social network game.  The problem is that with each new iteration there is an outcry from users even louder than the one before.  Similarly Skype, a program I use daily, has been trying to push itself more as a video chat program and has changed its layout so much as to become completely convoluted for anyone who DOESN’T want to use it for video.  The Skype interface became so bad that I actually rolled back my copy to an older version number and have it set not to update itself.  After browsing the Skype forums I can safely attest that I’m not the only one either.  Changes such as these have actually made the modding communities for each product become more prominent than ever before.  If there is a program feature that has been removed or an interface broken you can almost guaranteed that somewhere there is a programmer who has put it back the way it was.

What can software developers learn from this?  Simple, new features and content are good but don’t force them on your users.  As a rule Google has always gone about rolling out new features in the right way.  When they first introduced Search background images they had an option to turn it off not a day after it launched.  Similarly, they have recently opened up the option to test the new layout for Gmail and are actively requesting feedback.

While I would be happy to go back to the Windows 98 Start menu, reinstall Word 2003 and boot up Media Player Classic I suspect there are some of you who actually like the changes.  So where do you stand?  Let me know in the comments below.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

Happy Halloween from everyone at IT Computer Support of New York!

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

Apple released its much-anticipated MAC OS X Lion operating system back in July with over a million downloads in the first day.  Lion is an electronic download only, available for $30.00 from the online App Store.  This new operating system touts many new features and designs which Apple claims will make the user experience simpler.

Now that some of the new release hype has worn off let’s see how the OS stacks up.

Preparation

Prior to downloading Lion I performed a full Time Machine Backup of my MacBookPro and also created a bootable image using Carbon Copy Cloner in case I needed to revert back.  Once this house cleaning was complete I downloaded Apple OS X Lion from the App Store.  Since it was about 3.75GB in size this took about 45 minutes to download using my home ISP connection.  Prior to going through with the installation I copied the Lion installation file to a bootable DVD in case I ever need to reinstall.

Installation

Installation was a breeze and it took about 45 minutes to complete.  All my data and settings remained in tact with no issues.

First Impressions

When the computer rebooted I was greeted by a new and sleeker looking login screen, which immediately removes any doubt that this is a new operating system.

One of the top new features introduced is Gestures which allows a user to use the trackpad for zooming, swiping pages and various shortcuts.  Upon first login you are introduced with a quick tutorial on the Gestures feature.  After testing this for a few minutes it was easy to see how this can become quite handy but will take some getting used to.

With Lion Apple has reversed the traditional way of scrolling calling it ‘Natural Scrolling’.  This scrolling feature now mimics the iPad scroll on a touchscreen, so when you want to move up on a page you need to scroll down on your mouse and vice-versa.  For Apple Mac/iPad users this can be annoying but acceptable, for users that switch between PC and Mac this reverse scrolling feature can be a deal breaker since it changes the way we’ve used this feature since we learned computers.  Fortunately ‘Natural Scrolling’ can be disabled in the System Preferences returning the scrolling action back to default.

Full Screen mode for applications has been highlighted in Lion, basically it allows any application to go into full screen mode with a click of a mouse.  What makes this feature beneficial is that it allows the application to take up the entire screen(even hiding the operating system toolbar) so you can concentrate on the task at hand.

The Mail, Calendar and Contacts applications have been completely revamped and now look/feel like the versions on the iPad.  The Mail application is especially refreshing since its simplified interface and new look make it easy to work with email.  Conversations view has been added to allow for easier email management and a connection to Exchange Servers 2010 is supported.  Since we use Exchange 2010 at work I’ve been battling with finding an acceptable email client since moving to the Mac platform.  I tried Outlook 2011 and the old Mac Mail programs but these would perform sluggishly and didn’t offer the true Outlook experience you get with the PC version so I used Outlook Web Access instead.  Now with the new Mail program I will attempt to finally use a true email client but the verdict is still out.

Autosaving and Versions has been introduced with Lion, which allows you to revert back to a document draft like you can with TimeMachine.  The operating system automatically saves a version of the document in the background.  The concept is good but it only seems to work with Apple applications, I tried with MS Office and the Versions option was not available.

I tested all my daily applications and they all worked except for Java which I had to download from Apple.  To my relief BootCamp(Windows XP dual boot partition) also worked flawlessly.

Verdict

It’s clear with the release of Lion that Apple is pushing the look and feel of its iPad IOS unto the Mac operating system.  Features such as Gestures, Natural Scrolling and LaunchPad is evidence of the direction Apple is heading into with its operating systems.

The fact that I was able to perform this major operating system upgrade with no issues, my data/applications intact and my XP dual boot partition in working order makes this a success.  I would never have thought to perform a similar upgrade going to from XP to Vista or Windows 7, always opting to perform a clean installation instead to avoid compatibility issues.

Lion offers no noticeable advantage in performance over its predecessor but its 250 new features and upgraded Mail application should provide users with plenty of reasons to upgrade.  It will take months to truly evaluate Lion and discover all the new features but in the meantime there’s plenty to keep us busy.

Related Articles:

Get your Mac ready for Lion

Burning a Lion Boot Disc

Apple OS X Lion 250 Features

IT Computer Support of New York recently hosted a series of Lunch and Learn presentations on Cloud Computing.  The first batch of presentations was a big success so we are now opening signups to a larger audience.

The Cloud events are free “lunch and learn” presentations that are split into two demographics.  The first has a focus on medical practices and details the benefits of Cloud Computing and provides EMR stimulus information.  The second of the Cloud presentations provides a general overview of security concerns and benefits for financial institutions.  If there is enough interest we have plans to further broaden our topics to cover general business practices.

IT Computer Support of New York will continue to host monthly presentation on cloud now through the end of the year.  The next presentations will be held on October 19^th (Financial) and October 20^th (Medical).  If you are in either the medical or financial industries and would like to learn more or reserve a seat call us at 212-242-2949 and ask for Bill Checklowski.  While we will be hosting more “lunch and learn” events in coming months space is limited and if our last events were any indication will fill quickly.

For more information view our invitation flyers online at the following links:

Medical

Financial

Solid state hard drives have been available to consumers for a few years and available to military and industrial markets since the mid 90’s but it has only been recently that they have become affordable.  Solid state drives (SSDs) are different from normal hard drives (HDD) in that instead of storing data on spinning disks with moveable read/write heads they store information in memory chips.  The added benefit here is that the lack of moving parts makes them silent, faster and less likely to have corrupt data.

I recently had the opportunity to test out an OCZ Vertex 3 120GB solid state drive so let’s see how well it compares in a real world test.

Price

The first thing you need to consider if you want a solid state drive is the price, which is undeniably more than you would pay for a comparable normal hard drive.  The price per gigabyte for normal hard drives has plummeted over the last ten years. Storage is cheap and it’s now more likely that you will upgrade/replace your whole computer before the hard drive becomes close to full.

Note: because normal hard drives have become so large and cheap we can’t do a direct comparison based on size.  Instead we have compared the drives on price per gigabyte.

Price Comparison

OCZ Vertex 3 120GB (SSDs)
$2.50 /price per gigabyte

Western Digital Caviar Black 1TB (HDD)

$0.10 /price per gigabyte

In this case the direct comparison speaks for itself. The price for SSDs has decreased significantly in recent years but they still have the price of a luxury item.

Victory to Western Digital Caviar Black (HDD)

Access Speed

Here is the important category for those interested in a solid state drive and where the hardware really shines.

OCZ Vertex 3 120GB (SSDs)

Speed: 530 mb/s and 1ms access time

Western Digital Caviar Black 1TB (HDD)

110 mb/s and 12ms access

As you can see from the above numbers the SSD is able to transfer data almost five times faster than a normal high end hard drive and can read written data a full 12 times faster.

Victory to OCZ Vertex 3 (SSDs)

Reliability

In the early years of SSD development they were not known for their sustainability but as the technology improved they have become known as one of the most reliable ways to store your data. While we obviously can’t test this ourselves SSDs have an estimated life span of 50 years. Comparatively, normal hard drives are prone to failure over time based on usage and have an estimated life span of 5-8 years.

Victory to OCZ Vertex 3 (SSDs

Other Considerations

Noise:

SSD- SSDs have no moving parts and make no sound

HDD- HDDs have moving parts (heads, spindle motor) and have varying levels of sound depending upon model.

Victory to OCZ Vertex 3 (SSDs

Secure Data:

SSD- Data cannot be securely erased by overwriting the original file without special “Secure Erase” procedures built into the drive.

HDD- HDDs can overwrite data directly on the drive in any particular sector.

Victory to Western Digital Caviar Black (HDD)

Power consumption:

SSD- High performance SSDs generally requires 1/2 to 1/3 the power of normal HDDs.

Victory to OCZ Vertex 3 (SSDs

Final Thoughts

Solid state drives offer vastly superior performance over there standard hard drive counterparts but this performance comes as a hefty cost. In my own tests computer boot up times have been decreased by roughly 15 seconds and many of the programs I use everyday have had the operation lag cut in half.

Despite this performance boost solid state drives are not for everyone. If you primarily use your computer for word-processing, basic internet usage and other light activities you probably won’t see a big enough performance boost to make the price worthwhile. However, if you are a graphic designer, video editor or any other high impact computer user the difference a solid state drive will make will be night and day.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

Gesture recognition has long been the favored interface for Hollywood science fiction movies but recent developments have made this technology a reality.  Microsoft released the Kinect, a motion capturing interface device for its Xbox gaming system less than a year ago but already have plans to use the same technology beyond gaming.

Originally, Microsoft had plans to use the Kinect with the healthcare industry.  Because the Kinect tracks body movements it becomes possible to manipulate three-dimensional objects in real time through hand movements.  This capability makes it ideal to view renders of MRIs and other body scans.

Now it appears that Microsoft is looking past the health care industry and wants to apply this same technology to everyone.  The idea is that dynamic gestures could be used to navigate business applications for use with presentations and demonstrations when having a mouse is not ideal.  Microsoft’s Dynamics MVP recently had this to say on his blog in regards to the program:

“(E)arlier this year, I saw Business Analyzer (Available with Dynamics GP 2010 R2), and how it let you add beautiful KPIs (key performance indicators), Charts and Graphs to your personal dashboard. What if we let people navigate Business Analyzer with their gestures. That seemed like a good fit – and could be used in meetings!

“Microsoft has done a great job with the Kinect SDK and the Kinect ToolBox. Using the two I was able to track 4 gestures, and then send commands to Business Analyzer to navigate through the reports.”

The potential of the Kinect is definitely intriguing but I wonder how willing users would be to accept such a change in input devices.  I’ve also heard that the current consumer grade Kinect suffers from input latency and can experience problems based on lighting conditions.  Regardless, it will be interesting to see what Microsoft comes up with and even more interesting to see if the general public will embrace it.

Do you have experience with the Kinect?  Know of a program in the business world that would benefit from this technology?  Let us know!

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

Lately it seems like Google adds a new service to their lineup just about every week and the trend will continue with their new web host service.  Hosting user content is nothing new for Google; they already host millions of gigabytes of data for services such as Blogger, Picasa and Google Sites but now they plan to do something different and this time for a price.

Google will now provide a combined hosting and speedup service for customers’ websites.  As part of the service Google will reengineer hosted websites to comply with web standard best practices.  Unlike other Google products the new service will also cost a currently unannounced price.  Engineering manager Ram Raman described the service as follows:

Page Speed Service is an online service that automatically speeds up loading of your Web pages. To use the service, you need to sign up and point your site’s DNS entry to Google. Page Speed Service fetches content from your servers, rewrites your pages by applying Web performance best practices, and serves them to end users via Google’s servers across the globe. Your users will continue to access your site just as they did before, only with faster load times. Now you don’t have to worry about concatenating CSS, compressing images, caching, gzipping resources, or other Web performance best practices.

Speculation also suggests that by allowing Google to rewrite a websites code that their own proprietary browser Chrome will receive performance boosts by having content written specifically for it.

While the idea of Google hosted and rewritten websites is intriguing the prospect leaves a lot questions unanswered.  As a web developer I have encountered many websites that have been cobbled together in such a way that code fixes can take hours and still not match the original designs.  If Google plans to reengineer every site they host it begs to question how accurate the end product will be and how much the service will cost.  An even greater concern is accessing the data once it’s hosted on the Google service. Will users be able to make fast changes to the website and produce backups or will they be at the mercy of a Google technician.  If Google can pull off a successful launch of the service they could help revolutionize web design but as it stands now I’m skeptical.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

Google has innovated on just about every facet of the modern internet experience so when they announced that they would tackle social networking next, a lot of people paid attention. The Google Plus Project or Google+ sets out to be a direct competitor for Facebook. Many of the features are the same and even the overall appearance shares a lot in common. After a week of hands on experience let’s take a look at how Google’s young protégé measures up to the Facebook juggernaut.

Interested in receiving your own Google+ invite? The first three people who post comments in response to this article will have the chance to receive exclusive invites.

Interface and Appearance

Anyone who is familiar with Facebook will be at home when they see the Google+ interface for the first time. The two applications offer a very similar layout and appearance with the update stream running down and the middle, groups on the left and friends on the right. Google+ benefits from the fact that it isn’t cluttered with ads and has a slightly more streamlined appearance but overall the differences are marginal.

Because of their similarities and nearly mirrored interface there is no clear winner.

Both platforms are clean, efficient and attractive.

Stalemate!

Users

The ability to find friends and family on a social network is arguably the most important feature and with over 750 million users around the world Facebook is hard to beat. That said Google+ has been open to the public on an invite only basis for less than a month and already has over11.5 million users. Last Tuesday when Google+ allowed users to invite others that number grew 22% is 24 hours.

Google+ also has an advantage over Facebook in one key area. Everyone with a Gmail account will eventually have direct access to Google+. The two applications are directly integrated as part of Google Applications. This means that when Google chooses to release for a wide market the number of users will skyrocket.

Still, the future is just speculation at this point and at least for now Facebook has the upper hand.

Victory goes to Facebook

Features and Functionality

Facebook has been the reigning champion in this arena for a long time and already bested its previous competitor, Myspace. What then does Google+ bring to the table?

Circles

The big draw of Google+ is the way they have chosen to allow users to separate different parts of their lives. Users can create their own custom circles and add people by dragging them in from a list of contacts. This allows for users to have all contacts on a single account but still keep private matters private and out of view of casual acquaintances. Perhaps the best part of this feature will delight anyone who has been annoyed by a contact who spams their own wall with comments. If you place a contact into the Acquaintances Circle you will only see their updates if you choose to, regardless of which circle they placed you in. For people worried about hurting people’s feelings its notable that circle placement is completely anonymous.

Personal life privacy is one area of social networking sites that has received a lot of press recently, primarily directed at recent graduates. Unflattering photos and wall posts create a major problem for people who apply for new jobs and destroys credibility among those who already have them. In this way Circles create a safe zone between personal and professional life.

Hangouts

Hangouts are a simple idea that has the potential to grow into something huge. At the most basic level hangouts allow Google+ users to view live video streams and participate in live video-chat simultaneously. Currently, the video streams seem to be limited to YouTube but if other sources were opened up I could see this be a great tool for business conferences as well as casual entertainment.

Cross Application Integration

Since Google already controls many of the productivity tools people use every day such as Google Maps, Gmail, Blogger, and video communication it’s no surprise that all of these have been integrated with the Google+ platform. Google has essentially produced an all in one box solution that will probably both appeal and slightly frighten many users.

Facebook Games

Somewhat amusingly this is the one defining characteristic from Facebook that Google+ has not touched on. Games have been a part of popular Facebook culture for years. From a personal standpoint I consider the lack of games an improvement as it will reduce the amount of spam received but your personal opinions may vary.
Google has produced a full featured platform that provides a more customizable and mature social networking site.

With everything Google+ has built in and with a number of new features planned for the future it’s easy to give them victory.

Victory goes to Google Plus!

Final Thoughts

Google+ and Facebook are neck and neck in the social networking wars and there is no clear victor as of yet. Facebook has years of experience and a huge dedicated fan base but Google+ has experience in every other area of the web experience and the resources to pull everything together.

As standalone platforms neither is truly superior yet but the advantages of each will likely split the communities. Google+ is likely to appeal to a more technology sophisticated and business oriented group of users while Facebook will always appeal to a more casual audience. Which network you prefer will likely come down to personal taste.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department

If you’re like most people you’re curious to see what Google has to offer in the way of its new social networking platform.  However, there is a problem.  Facebook scammers have set up a way to use this curiosity against users and hijack their accounts.

The most recent version of the scam consists of a Google+ fan page with a description that promises Google+ invites to anyone who “likes” the page.  When a Facebook user does so they not only give the scammers access to their account but all your friends and family are encouraged to sign up for the scam from your account.  So far an estimated 80,000 people have fallen for the scam so it’s a very real threat for the unwary.

If you encounter this scam or any other the first thing you should do is report it to Facebook Security.  The sooner Facebook is aware of the threat the sooner it can be removed.

- Richard Keene
IT Computer Support of New York
Design and Optimization Department