CanadianEMR: EMR Comparisons, Ratings, Directory Services and Expert Discussions

Computer Setup - Example 7

This exam room configuration demonstrates the computer setup in a primary care office. The desk is curved and indented so the patient and screen are beside each other.  This means the physician can see the patient and the computer screen in the same glance.  There is no necessity to move one's body when glancing from patient to screen.  The patient feels more the centre of attention.

As well, there is an ergonomically correct (height and orientation) keyboard drawer.  The keyboard and mouse are not on the desk...liberating space and easing comfort.

There is room to the right for a small printer (in this case the HP 1012 laser printer which has a footprint of only 15").

I find this is the only really workable way to be entering data with the patient the centre of focus and not the computer.  Of course the screen can easilly be tilted for patient viewing although I find I'm happy to not share my notes as I make them most of the time!

If you would like to comment on this configuration, please click on the 'Comments' link below.

Computer Setup - Example 6

This exam room configuration is submitted by a physician who uses a Macintosh-based EMR system for his practice. Each examination room has a similar setup. The practice has multiple iMac machines which have an extremely small footprint (base size).  As a result, desk space is maximized. The physician sits at his desk with the patient sitting to the right side. The patient can easily view the computer screen, or the screen can be swivelled for viewing.

Also, note that each exam room has a printer which is placed on the desk to generate letters and prescriptions at the point of care.

This is a second view of the room from the doorway. Note that the door opens towards the bed providing greater privacy to the patient. The only element not visible is the sink and its adjacent counter with sharps container, alcohol and swabs, which are behind the door.

If you would like to comment on this configuration, please click on the 'Comments' link below.

Computer setup - Example 5

The above images are provided by a regular contributor to CanadianEMR. As he describes: I decided to go with brackets as our counter space is very limited and I wanted to keep the laptops away from small hands when neccessay. As I only use the EMR for prescriptions, I can move the laptop aside and store it when I am working with a paper chart. Positioning the laptop on the bracket gives me great flexibility. If you have had similar experiences or would like to comment on the above configuration, please click on the 'Comments' link below.

Computer setup - Example 4

This image has been provided by Dr. Karim Keshavjee and demonstrates the computer configuration in an exam room from the COMPETE study that was carried out in Hamilton, Ontario. In the image, a keyboard is mounted on a sliding tray under a traditional desk. The monitor (CRT) is mounted on a flexible arm off the corner of the desk to be minimally intrusive and is positioned so that the physician and patient can view the screen at the same time. As you can see, the physician is entering data using a touchpad and pen. If you would like to comment on this layout or have suggestions on how you have used a similar layout, please click on the 'Comments' link below.

Computer setup - Example 3

The following has been submitted by a contributor to CanadianEMR. Alan, I really enjoy your site, when I get a chance to peruse it. I moved my office 10 years ago and used the services of an office designer. I work in a 2 physician, 4 exam room office. She was very helpful in coming up with a floor plan and colour scheme etc, but when it came down to the nitty gritty I did some of my own research in the specific layout for the exam rooms. I thought - who are the most efficient physicians practicing at the present? Of course, dermatologists! Fortunately I found a contractor who had done work for a very successful dermatology practice and we were able to copy the layout of their exam rooms. Being lucky again, when we started EMR in 1998, the setup adapted quite nicely to adding the CPU, keyboard, touchpad and monitors. I have attached some photos of one of my rooms (which I took with my new Palm Zire 72!). All the other rooms are identical. We use YorkMed/Purkinje with the workstations running on Terminal Server. As I was told initially any old CPU that was being used as a doorstop can be used in the workstation. In 2 other rooms I actually use 2 old laptops tucked under the desk. This essentially allows me to sit at the desk facing the patient, using the touchpad to enter data. The one pictured is an old "Manta" pad, the newer Wacom tablets can also be used and will actually allow input via handwriting recognition. The flat screens are a later addition and are certainly less obtrusive and allow other uses for the desktop (eg sorting out patient's pill bags!!). Overall a very satisfactory setup which evolved with some planning and some luck. The identity of each contributor is protected for security reasons. If you would like to post a comment, please click on the 'Comments' link below.

Computer setup - Example 2

This image was submitted by a contributor to CanadianEMR of one of the exam rooms. There is a flat panel monitor on a moveable arm attached firmly to the wall and the computer(s) are located alongside the exam table in easy reach, but protected by the table. A regular keyboard is used to input consultation information and the lower end of the bed is used to rest the keyboard. The keyboard can then be moved out of the way when the patient is examined. If you would like to post a comment or a question, please click on the 'Comments' link below.

Computer Setup - Example 1

The following information and photos are provided by a contributor to CanadianEMR: This is the setup in exam room "2". The monitor is a Benq 17" that I got on special for under $500. The other rooms have 15" Samsung LCD monitors for under $450 each. I use inexpensive computers ($450-$500) with 2.4 to 2.8 GHz Celeron processors with 256 MB of RAM. Most are inexpensively upgraded to 512 MB to improve voice recognition performance. The microphone is a Shure SM58 from Long & McQuade, a musical instrument store, costing about $150. This is a really solid instrument and is considered a workhorse for vocalists in the entertainment industry. It is delightfully unidirectional and noise limiting. The mic cable is a little harder to find, but can be ordered from Long & McQuade. It features a standard 1/8th inch plug for the computer sound card on one end and an XLR female connector for the microphone end. It works well without an impedance matching device. I use Dragon NatuallySpeaking Preferred ver 7.3 voice-recognition software, available at Future Shop for under $200. Over the past several months I have added quite a pharmaceutical vocabulary as I go along as well as "macros" of medical phrases in the usual format such as "cranial nerves to II to XII within normal limits". There is a surprising large medical vocabulary right out-of-the-box even though this is not the "medical" edition. For example, such terms as the words in the phrase "epidural, subdural or subarachnoid hematoma" were already in the software's vocabulary.   As seen in the photographs, the Gyration wireless keyboard is about the size of a laptop's keyboard and is a great space saver. If I am doing a procedure and need the space for other instruments, I simply move the keyboard. The absence of wires makes this effortless. With this setup I can equip four examination rooms for the cost of one tablet and a spare. The equipment is more secure and more comfortable to work with and affords a good degree of redundancy. There is not much new to show here in Exam Room 1 and 3 except to demonstrate that the available space is very modest but that it accommodates the computer equipment very easily. An electrician was hired to provide electrical outlets in the bottom cabinets. The only other modification was the hole drilled through the counter to accommodate the monitor wires. One more note about the Gyration keyboard and mouse - each of these wireless devices can be selected to operate on one of 8 available channels. Since adjacent examination rooms are likely to be within range of the devices, one is limited to operating a maximum of four keyboard and mouse combinations at the same time. Any other computers will need to use a different system. If you would like to post a comment, please click on the 'Comments' link below.