INCC

Infrastructure Punch List (To-Do List) for Centers

Hardware/Networking for PMS and EMR

The purpose of this document is to outline the steps needed to determine the type and number of hardware devices required at your health center based on the center’s workflow and your decision to go with wireless or wired devices. Equipment specifications will be provided in a separate document as those purchases are likely made by different staff than those making these decisions.

I.KEY DECISION: Wireless Devices or Wired Devices (to be determined three to six months before center’s planned Go Live-in most cases this would apply for only clinical applications Go Live)

  1. Wired EMRs: The computer is usually stationary at the point-of-care; traditional desktops or locked-in laptops are the most common.
  2. Wireless EMRs: The computer has a receiver built into it.

1)It receives signals from the wireless system.

2)Secure technology allows providers to carry around a tablet that feels like a clipboard.

  1. Internet resources to help you to determine whether wired or wireless is best for your center:

II.TIMELINE

  1. For Health Centers planning to use WIRELESS

1)Arrange for a wireless site survey as soon as determination is made to go wireless (see Section A, #1 below)

2)Order wireless access points (WAPs)(see Section A, #2 below – eight to twelve weeks delivery time is the norm for Cisco WAPs from TechSoup.org)

  1. For ALL Health Centers

1)Order all equipment (including any wireless devices) at least three or more months before your center’s scheduled Go Live-again in most cases for clinicalgo live(three weeks delivery time for most vendors).

2)All equipment should be delivered, installed, tested, with all potential problems resolved by two or more months ahead of your center’s planned Go Live.

III. CHOICES

  1. If Wireless

1)The first step is to make arrangements for a wireless site survey. A wireless site survey is a radio frequency (RF) site survey. It is the first step in the deployment of a wireless network and the most important step to ensure desired operation. A site survey is a task-by-task process by which the surveyor studies the facility to understand the RF behavior, discovers RF coverage areas, checks for RF interference and determines the appropriate placement of Wireless devices. For more information on what a wireless survey is and “Frequently Asked Questions”, go to:

2)INCC can make a recommendation for a preferred contractor to perform your wireless survey if you are going to go wireless and don’t have a local contractor to perform this service. The performance of the wireless system will be incredibly important. So we would ask that before any purchase of equipment or installation efforts are initiated those plans be shared with INCC to ensure alignment with our specifications.

3)The next step is to order:

  • WAPs (These are Wireless Access Points)
  • Power injectors (e.g. Cisco Aironet Power Injectors provide inline power for Cisco Aironet 1100 and 1200 series access points and 350 series access points and bridges)
  • Additional equipment--Managed switch for WAPs (A “managed switch” allows you to control the individual ports of your switch. Features of course vary with manufacturers and models, but even the most basic will have the ability to turn the port on or off and control its link speed and duplex settings. That control is for security; it prevents someone just walking in and connecting to your LAN through an unused port.)

4)Install and configure devices to comply with HIPAA guidelines. The majority of the PMS/EMR systems HIPAA Standard compliance will be handled by the EMR software and the Inconcert Windows environment. If the center has chosen to utilize wireless networking then extra care must be taken when designing, implementing, and administering the wireless network to ensure HIPAA compliance. (We have information sources for HIPAA compliance which is available upon request.)

5)Determine the number of devices according to the number of providers and the number of clinical support combined.

6)Order one extra battery per device and plan for charge stations for extra batteries. You will need one charge cord per exam room and an average of one per nursing station.

  1. If Wired

1)Wire each exam room, nursing station, and every location where devices will be needed. (Consider HIPAA implications: order privacy screens where needed at least two months or more before go live.)

2)Order managed switches for new device drops. Identify optimal ergonomic location for device in each exam room, nursing station and other locations prior to ordering equipment.

3)Order one device per exam room plus additional stations as needed for clinical support staff.

IV.MEDICAL RECORDS & SCANNING

A.Use fixed PCs for scanners (you must use PCs where ever scanning will be done).

B.Order one PC per medical records staff (Note that for ergonomic and workflow efficiencies, we recommend staff who scan each have a dedicated PC with scanner at their station.)

C.Scanners

1)Minimum of one per three provider FTEs

2)Maximum is number of Medical Records staff PCs

3)Scanners must be “slaved” to a PC

4)Scanners may be desired at locations where other full page scanning is needed (e.g. referral coordinators or front desk staff for proof of income documents).

  1. Consider workflow changes to centralize all scanning within the center, even if it is currently not centralized. Centralized scanning is much more efficient.
  2. Insurance card scanning is usually done at front desk, but only one scanning device should reside on one PC.
  3. If page scanning is anticipated (at front desk or elsewhere), then do not use card scanner at that location.
  4. Remember:

1)Scanning mustbe done on a PC to which it is “slaved.”

2)A thin client device cannot be used

V.End User (Provider and Support Staff) Devices

  1. Lap tops and tablets- INCC, with consultation from G.E. Centricity, Alliance staff, and Craig Law, will narrow the pool of device vendors down to two or possibly three for lap tops and tablets, and score them. Loaner samples of the preferred one or two devices will then be provided to centers as loaners so that providers and other end users can trial the device to determine what each center wants to order.
  2. Desk tops - An inventory of the features (i.e. is it a thin client?), size, and age of existing desk tops should be made to determine if they will be compatible and adequate for the G.E. Centricity system and the applications/features the particular users of the desk top will need to have access. The inventory should include the role of the staff member using the desk top. If you want to use thin clients in exam rooms or for staff, then the PM/EMR is the ONLY application you will have access to and if you will want other things (email, MSWord, IE) then PCs should be chosen.

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