Last year I started with a desktop scanner. A nice little Fujitsu duplex straight feed model 5110C. It does color and black and white, great software, good resolution, okay speed (15ppm).

While cruising my favorite shopping site eBay, I noticed a plethora of used Fujitsu M4097Ds being unloaded from business use. This model had both flatbed and ADF capability, duplex, and better speed (50 ppm). Only thing is, I needed to get a SCSI card. I ‘ll let you know haw this works out after I get hooked up.

Anyone have any thoughts, feelings, insights, suggestions, rants, etc.?

Mission-critical features included:

• Print, copy, fax, scan
• Flatbed
• Laser - for business correspondence and long-lasting medical records files
• ADF
• Duplex capability
• Price under $500
• Reasonably priced consumables (toner & drum)
• Reasonably good reviews
• Not TOO big - has to share counter space
• Reasonably simple button layout and UI - as some office staff are “technologically challenged”
• Reasonably fast warm-up

Optional features that would be nice, but I could live without:

• Color
• Networking - only have one computer to connect to
• Price under $400 - have to watch out for inexpensive, consumer grade machines that would not have the duty-cycle needed in a small business/workgroup setting
• Fancy software - already have Adobe acrobat
• Available locally off-the-shelf (Staples for instance) would get me back up and running

So the units that I found that met all of my requirements included:

• Brother MFC-8860
• HP LaserJet 3390
• Canon MF6550

Ultimately, I chose the Brother MFC-8860DN Multifunction Printer ($472 at Buy.com). I had to wait a few more days for delivery, but I’m glad that I did. I did not mind staying with Brother. Even though some reviewers had had bad experiences, I have had a total of four other different Brother machines without major difficulties.

Conclusions: Setup was easy, printing is great, duplexing is easy. It is quiet, speedy, solid and exceeded my expectations. I would recommend you consider getting one of these babies yourself.

[tags]Brother, MFC, MFP, AIO[/tags]

To attempt to make this seem palatable to physicians, CMS and Congress have invented the Pay for Performance (P4P) program, that will offer to physicians a small “bonus” payment if they spend all year jumping through hoops to prove that they know how to practice medicine. Not by keeping their patients out of the hospital or saving someone’s life, but by correctly tracking, collecting, and submitting dozens of brand-new code numbers.

This is obviously just throwing a small bone the physicians’ way, because they count on Dr. Average not having the wherewithal to submit enough numbers to qualify for any reward money. Sounds like the game invented by the third party payors when they noticed that it was to their advantage to initially deny claims, even when they knew they were valid, because so few physicians noticed and resubmitted them.

Dr. Whited gives his take on the pros and cons of this plan in the letter he wrote to MD Net Guide which is available for viewing in Second Opinion and in the full post.

Hopefully this will get some discussion going ;-)

Philip A. Gilly, MD, FAAFP
Family Physician, computer enthusiast, digital photographer, Webmaster and Internet content creator.

Philip owns and operates a low-overhead solo private practice, the Kinderhook Wellness Center. Maintains the Kinderhook Connection Web portal, which provides Web content services for a local medical office, medical society, bookstore, and business association, as well as news and information about the historic village of Kinderhook, NY. As for the print media, he has been published in two medical journals, has had numerous articles published in local newspapers on medical issues, and serves as a reviewer for Family Practice Management.

[here's the story...]

SECOND OPINION

The news items and articles on pay for performance (P4P) we have included in recent issues of the mdng.com magazine and in our eDigests have generated some interesting responses from our readers, one of whom wrote to convey his thoughts on EHRs and P4P(April 2007)

To P4P or Not to P4P…

You might he interested in some of my recent experiences with an EHR and how it affects the doctor patient relationship. As a solo family practitioner with no EHR, I have already begun to see patients who tell me the reason for leaving their last MD was that “he spent the entire visit looking at the computer!” I am sure I have lost patients who will complain to their new physicians that “Dr. Whited is just too low tech!”

My practice is totally devoted to interacting one on one, face to face with the patient and I do not intend to change. If I am ever forced to use a computer as a medical record, I will wait to enter data until after the patient visit is over to avoid losing my focus on the other human being involved in the interaction. I feel I will always (at least for the next decade until I die or retire) have plenty of patients interested in a physician who is interested in them as a person and not as data on a computer screen. Despite my degree from MIT, I am not much of a geek and if this dooms me for a medical career in the future, so be it.

As for P4P, you bet I will cut my more noncompliant patients loose. Below are a couple of examples. I recently diagnosed a 35-year-old male as diabetic and sent him home with a free monitor, logbook, prescriptions, and all kinds of instructions and educational materials (that office visit was a real dog and pony show). A week later, when I asked to review his logbook of home glucose monitor readings, he said he had none. When I asked why not, he admitted he had not purchased the glucometer test strips necessary to perform the home monitoring of his blood sugars. When I again asked why not, he stated that the cost of $85 for a three-month supply was too much (apparently his insurance did not cover this although they pretty much paid for everything else). I asked him if he had cable TV. He looked at me like I was demented and told me, “Of course I have cable TV” I then asked him the cost of one month of his cable TV. As it turned out, it was about $85. I told him that since he did not consider his health to be worth the cost of one month of cable TV he should know that, as an old dude, I can remember when there was no TV at all and that no one died from the lack of TV. I explained that he was definitely at increased risk of dying prematurely if he did not monitor his sugars. His response? He did not return for any further visits. I guess I do not have much of a future as a diabetes educator. Had he returned, I would have tried further education and done my best, with or without his compliance, to treat his diabetes and minimize the complications thereof. However, under P4P, this idiot would have been instantly dismissed from my practice. I’ll give you another example. I was treating a slightly older diabetic lady whose sugars would not come under what the guideline defines as good control. During a long discussion about her diet (which she stated she was following), she revealed that the previous day she had a McDonalds cheeseburger and fries for lunch, and a dinner of stew with lots of potatoes and dumplings on top (carbs, carbs, and more carbs). She then admitted that she had peanut M&Ms for snacks and dessert, as they were her favorite. When I protested that this was a diet that would drive her sugars through the roof and cause her to have preventable diabetic complications (including death), she stated, “I do not want to die, but I am not going to live that way” (meaning without M&Ms, dumplings, potatoes, etc).

Currently, I have agreed to try to work around her non-compliance as best I can, but when P4P becomes a reality I will be placing this lady on a slippery slide out of my practice and blocking the entry into my practice of other non-compliant individuals that my peers have just fired. Luckily, the incentives offered so far for P4P are so puny that I am totally unmotivated to do anything to join this movement. I mean, give me a break, 1.5%? My little solo practice is about a $500,000 a year business. A 1% bonus would amount to $5,000, or less than $500 per month. Big whoop! Even a 5% bonus would amount to only $25,000 per year and for this I would probably have to spend around $50,000 to obtain an EHR and $15,000 a year to maintain it. Excuse me for being underwhelmed, especially when I consider the hassle of changing my whole practice to accommodate the EHR. Thanks, but no thanks. And should this become, as I suspect, an unfunded mandate from the insurers and their lapdog, the government, well, cash only practice is looking better and better.

Everest A. “Tad” Whited, MD, PhD

[tags]Pay for Performance, P4P[/tags]

To commemorate its 25th anniversary, PC Magazine announces the PC Magazine Digital Love program, a technology equipment donation program, in partnership with the National Cristina Foundation (NCF), a not-for-profit organization dedicated to the support of training through donated, used technology. The program provides computer technology to people with disabilities, students at risk and economically-disadvantaged persons. Combined with training, this program enables them to lead more independent and productive lives. For more information or to donate online, please visit this site.

[Through the Digital Love Program] NCF provided [hardware] to Computers for Youth (CFY), a not-for-profit organization that takes donated systems and repurposes them into home learning centers for children. CFY installs education software, provides free Internet service and offers free tech support for the recipients of the systems. CFY distributes these systems to low-income children in selected schools.

This sounds like a double-good idea to me, and a feel-good as well! Any of you out there have any comments, ideas, or suggestions?

[tags]National Cristina Foundation, NCF, CFY, Computers for Youth, Digital Love[/tags]

It certainly seems like a neat, geeky idea!

Turning your living room’s coffee table into a touch-screen computer.

It features automatic input, but I guess not yet auto output. That is, when you set down an electronic device (digital camera, PDA, MP3, etc.), the computer will automatically recognize it as a data source, establish a connection, and suck out any data, er, I mean download. So what happens when you set down a cup of coffee? Better yet, will anything happen when you set down an empty coffee cup?!? It’s coming soon to a Sheraton or a Harrah’s near you!

I can see the Micro$oft Surface becoming a very, very upscale sort of media center, but I’m not sure it would replace my desktop or laptop for data or text-based work.

What’s your take on this?

Included in that - he wants a laptop computer. He has only ever used the family desktop at home, except the computer lab at school may have used notebooks. Of course, being the responsible parent that I am, I don’t want to get him a laptop so great that he spends all of his time watching DVDs, hanging out in Second Life or WoW, or becomes the dorm’s music source. Nor do I want a college freshman to have to learn how to protect his first laptop from theft, loss, and damage with a top of the line model.

Personally, I am fond of Toshiba models, as I have used a Satellite and a Portege for multiple years with little difficulty. The current Computer Shopper gives a good blurb on the new Toshiba Satellite P205. Last month’s PC Magazine had a nice “First Look” for the Toshiba Satellite A135-S4467. There have been ads for the Dell Inspiron E1405 and 1505 which seemed appropriate choices. I think my price point is going to be between 700 and 1000 dollars.

Anyone out there have any thoughts, ideas, comments, suggestions, or tips to share?

[tags]laptop, hardware, college, freshman[/tags]

Blogging has hit the physician mainstream. More and more physicians are contributing content online in order to increase the chance that surfers will have access to authoritative and less pharmaceutically biased health information.

• Grand Rounds - a weekly review of the best blog posts by healthcare bloggers.
• Doc Notes - commentary on topics of interest to Primary Care physicians, highlighting technologies helpful to smaller practices.
• Straight from the Doc - popular medblogger
• medmusing - a medical informatician and urgent care physician
• DB’s Medical Rants -
• Signout -
  
• Medpundit -
• MedViews -
• SoloDoc - a Family Practice Doctor goes from HMO to Solo
• Kinderhook Wellness Center - This one (of course, silly wabbit !)

Healthcare consumers are flocking to the ever more qualified content that is becoming available. Let us know what your favorite medblogs are.

Philip A. Gilly, MD, FAAFP
Family Physician, computer enthusiast, digital photographer, Webmaster and Internet content creator.

Philip owns and operates a low-overhead solo private practice, the Kinderhook Wellness Center. Maintains the Kinderhook Connection Web portal, which provides Web content services for a local medical office, medical society, bookstore, and business association, as well as news and information about the historic village of Kinderhook, NY. As for the print media, he has been published in two medical journals, has had numerous articles published in local newspapers on medical issues, and serves as a reviewer for Family Practice Management.

I found this great blog with all sorts of neat advice about optimizing one’s life, career and computing experience!

It is titled “Dumb Little Man” which I personally think robs it of alot of the credibility that it deserves.  I found myself copying list after list of useful hints.

Would be curious to hear your take on this.

So I signed up with the USPS NetStamps program. The software was very easy to install and use, a neat little postage scale was part of the offer, and no added equipment was needed, as the sheets of stamps could be printed through the bypass feeder of my laser printer. I could purchase stamp blanks with different designs, or make my own by uploading a photo or a graphic. I took advantage of this by making myself a logo, and again when I placed a text business announcement right on my stamps. However, there is a monthly service charge.

Recently I learned that DYMO is partnered with Endicia to offer the Print DYMO Stamps program that uses special postage labels with no monthly fee. On the other hand, I did need to add a peripheral to be connected to my computer’s USB port, namely one of the more expensive DYMO LabelWriters (Turbo or Duo) . There currently is no variety of stamp designs, but there is no monthly fee. The software is easy to set up and use, and the Internet interactions seem a little faster than with the USPS site.

I love being able to print out just the number of stamps that I need at that moment, in the variety of values for the different items. I highly recommend either of these two solutions for printing your own postage, depending on which features appeal to you most.

That’s just my opinion — what’s yours?

Philip A. Gilly, MD, FAAFP
Family Physician, computer enthusiast, digital photographer, Webmaster and Internet content creator.

Philip owns and operates a low-overhead solo private practice, the Kinderhook Wellness Center. Maintains the Kinderhook Connection Web portal, which provides Web content services for a local medical office, medical society, bookstore, and business association, as well as news and information about the historic village of Kinderhook, NY. As for the print media, he has been published in two medical journals, has had numerous articles published in local newspapers on medical issues, and serves as a reviewer for Family Practice Management.

[tags]SOHO, small business, stamps, internet postage[/tags]