Tech Rx

Does your 20-something IT wizard visit your practice more often than some of your patients? We've seen small medical practices that single-handedly keep the technology geeks in their town in business. If that's you, you have a problem.

Fortunately, you can eliminate many of the maintenance costs associated with computer crashes, sticky mice, flickering screens, and similar problems by doing some simple, free, routine maintenance on all the software and hardware in your office.

We've gotten so used to having computers at home, in the office, and everywhere else that we treat them like those old milk-crate bookshelves from our college days. Show a little respect. Think back to the day when that computer or printer came out of its box, so shiny and full of promise. It's up to you to make sure it stays that way.

It doesn't take much. Try the following simple steps.

Hardware help

Buy and use a surge protector -- A surge protector is never a bad idea. Better yet, for less than $30, you can purchase a workstation surge protector that carries an equipment protection policy. If the surge protector fails, you are still covered -- up to $50,000. Remember to complete the product registration to activate your policy.

Use screen savers and energy saving settings -- Using screen savers (those images that appear on the monitor when the computer has not been used for a while) is one of the single most fun and easy ways to make monitors last. Their purpose is to keep whatever is on your screen -- a spreadsheet, an e-mail -- from permanently "burning" onto the screen. Assuming you are using Microsoft Windows, set your screen saver by going to the control panel, then display, then clicking on the top tab for screen savers. You can select any screen saver there and also set how fast it should kick in if the computer is not in use.

In the same area, you can establish standards for power use -- click on the settings button that appears once you select the screen saver tab. Here, you even have the option to turn off the monitor automatically if it is not in use for a set amount of time.

Let the boxes breathe -- Don't suffocate your monitor by piling reports, manuals, notebooks, magazines, or stuffed toys on top of it. Take note of the air holes or slotted vents on the top and back of the monitor and position it so that air can circulate.

Get a cart -- Keep your central processing unit (CPU) -- the actual computing box -- off the floor. If it is on the carpet, it comes into contact with dust and dirt, gets knocked by the vacuum -- and you are more likely to accidentally kick it. Invest in a cart to keep it on or ask some handy person on staff to build plain, three-sided boxes that you can put the box on to keep it off the floor.

Keep it clean

Dust is the enemy of electronic equipment. First, keep all your equipment as dust-free as possible. Then, cautiously and carefully, use the appropriate tool, as recommended by the manufacturer, to remove dust.

Keyboards seem to be magnets for spilled coffee, soda, crumbs, and paperclips. If you do spill something on your keyboard, pick the keyboard up, turn it over, and shake it gently. Don't bang or slap the keyboard. And remember your mother's advice -- don't stick anything bigger than your elbow in your ear or your keyboard. That means no letter-openers and no tweezers.

The mouse also gobbles up crumbs, eraser shavings, and dust. If it's a mouse with a wheel, you can pop the ball out and clean it with almost anything (soap and water works fine). The key is to be sure the ball is absolutely clean and dry when you return it to the mouse cavity. Use canned air to blow into the cavity to clear it. Do not use anything to scrape the inside because you'll destroy the two spindles and the gummy strips that grip the ball to move the spindles. Bottom line: The mouse is very economical to replace. 

Tractor-fed printers generate a lot of paper dust. Vacuuming or blowing is always better than wiping, as a general rule. If you can replace the pin-fed printer with an inkjet, you'll reduce the amount of paper dust that gets into your other equipment, too. Poor quality paper will also contribute dust to your environment. What are the savings on bargain paper if the end result requires replacing hardware?

Cleanliness is next to godliness for inkjet printers, too. If you are getting poor quality prints, use the cleaning utility software your manufacturer provided that addresses the print heads as well as an alignment utility.

Printer cartridges from the printer manufacturer will perform most effectively over the long run, both for the hardware as well as for the lifetime of your print production. And please -- don't grab and pull paper if it jams the machine. Inevitably, some little corner gets ripped off and stuck in the machine, creating a bigger headache. Instead, follow manufacturer instructions on opening the machine, moving gears out of the way, and gently freeing the jam.

In general, keep in mind that replacement costs are often more economical than repair. A new mouse, a new printer (single-user, dedicated printer), or a new keyboard can be purchased for as little as $30 to $130. Hourly repair costs will easily reach the new product purchase prices, yet your repaired equipment may only be in a state of "it works" versus "as good as new." Don't hesitate to replace one of these pieces of equipment.

And always remember our recurring theme: read the manufacturer's product manual and follow the recommended maintenance routines.

Software solutions

What goes for hardware goes for software, too. Do what the manufacturer suggests. In particular, if you are running Microsoft Windows and Microsoft sends you a message offering a free update, take it.

Here are some other ways to improve software performance:

Reboot regularly -- The number one reason that a PC may not run effectively or as fast as the user thinks it should is because it has not been rebooted. You should reboot your PCs -- that is, totally shut them down and start them up again -- on a regular basis. Regular can mean anywhere from daily to weekly depending on use. Many software programs are not well behaved. The program leaks memory and your PC resources get too low to allow the CPU to perform optimally. With the act of rebooting, the resources are reset and the PC functions start anew.

Use it or dump it -- Another performance improvement task is to uninstall programs you don't need and archive data you don't have to have immediately on hand.

Routine maintenance should include regular emptying of your recycle bin and your e-mail trash or deleted folder. Clearing out folders and files improves your system's ability to handle new tasks.

Good organizational practices in storing documents can also make it easier to maintain a backup of your document files. The Microsoft My Documents folder is a default starting point for your data tree. You can create subdirectories based on file types or projects. The key is to find the filing mechanism that provides you with easy access for retrieval and one-step backup procedures. If it is too cumbersome to perform a backup, you won't do it, so keep it simple.

Back it up -- Backup routines should be based on how much you can afford to lose. Is there too much risk if you lose one day of data, or one week? The answer to that question will determine how frequently you perform your backup. A CD-ROM burner will support most PC users when data compression (zipped files) is also employed. What you do with that CD-ROM is as important as creating it. Store it off-site, not on top of the PC you just backed up. 

For your practice management system, your vendor should have recommended at least a 10-tape rotation for your backup. By using 10 tapes (one per day) for each day of the workweek (assuming Monday through Friday), you will always have your last two weeks of work backed up. This will mitigate your risk should a problem occur while attempting a restore. All those tapes should not be sitting on your server. Some practices negotiate a service with a lab courier who trades a blank tape for a backed-up tape each day and stores them off-site.

To ensure your entire backup process, be familiar with the restore process -- that is, what you will have to do with all those backup tapes if your system ever does crash. Document the specific steps and maintain those in paper format where they can be easily accessed; if you do have a crash, you won't be able to access online help or instructions saved in a Word document somewhere on your computer. Your vendor should be able to specify what the correct process is for your system. Make sure you understand every step - you might even do a test-run. Ask your vendor for help.

Defragment -- Another system utility is the defragment process (in Windows XP, it's found in My Computer/Control Panel/Administrative Tools/Computer Management/Storage/Disk Defragmenter). The "defrag" will re-optimize your hard drive, which again improves resource utilization. The key issues with the defrag process is the length of time it takes and how often it keeps restarting. The defrag process can be interrupted by incoming e-mail or when a screen saver kicks in. For an effective defrag, it may be beneficial to disconnect from the Internet to stop e-mails, deactivate screen savers, and turn off energy-saving functions.

Keep it secure -- Routinely securing your PC is another step to reduce the risk of inappropriate access and potential data destruction or file corruption. Activating a password with your screen saver is a simple way to secure your PC system. Activating the PC lockdown function by hitting CTRL-ALT-DELETE and "Enter" will keep others from accessing your PC when you walk away from your workstation. In Windows XP, when you hit CTRL-ALT-DELETE, the Windows Security dialog box pops up, and the "Lock Computer" button is highlighted, which accepts the "Enter" key for quick deployment. When you hit "Enter" or click on "Lock Computer" button, the Windows Unlock Computer dialog box pops up, and only upon entering your password  -- the same password you use when your screen saver has activated -- will you return the application you had been working in, thus securing, or locking down, your computer while you step away.

Password management is key to securing your systems. Simple rules to establish in maintaining an effective password policy are as follows:

• Each user should have a unique user ID and password
• Minimum password length should be six characters
• Passwords should include letters, numbers, and non-dictionary words
• Passwords should not be related to user (i.e., child, pet, maiden name, phone number, etc.)
• Force periodic changes every 60-90 days
• Delete passwords when employees are terminated or when a job function no longer requires system access
• Do not post passwords in a public area

Another, more sophisticated tool to secure your PC is the use of biometrics. A fingerprint pad on your integrated keyboard and mouse identifies the user by matching a fingerprint to an encrypted file maintained on the PC, permitting access only on matched prints. This one step beyond password protection is available today for less than $100.

A discussion about securing data would be incomplete without addressing antivirus software. Microsoft provides a Web page -- www.microsoft.com/security/protect/ -- explaining how to "Protect your PC in 3 easy steps." This site provides step-by-step instructions including screen displays for a very easy-to-follow set up.

Much of what we can do to keep our offices and equipment running each day involves common sense. And one of the simplest, no-cost options for equipment performance is reading and following the manufacturer's instructions. You'll find that these resources, whether online, on CD-ROM, or in a printed manual, are good places to start your efforts.

Rosemarie Nelson has experience as a medical office manager, in information technology, and as a consultant to physicians and practice professionals. She was manager of the multi-manufacturer Office of the Future project and serves on the board of the American Heart Association North East Affiliate. She was awarded the 2000 Professional Achievement Award by New School University, Robert J. Milano Graduate School of Management & Urban Policy, and has written numerous articles on practice management issues.

Gregory Kennedy has experience as a programmer, network engineer, and systems administrator in the healthcare industry, and as a consultant to physicians and practice professionals as well as hospitals and integrated delivery systems. He is currently a partner in a health information technology company providing systems and services to private medical practices. The authors can be reached via editor@physicianspractice.com.

This article originally appeared in the February 2004 issue of Physicians Practice.