Dr. Michael Bouchard is aware of the advantages of networking his office computers and having Internet access to meet the needs of his facility. Every day he and his staff send and receive many important e-mail messages to and from patients and other individuals. His staff members use the computer for communications and to access sources of online information. Patient tracking, accounting functions, and health information retrieval are immensely faster on a computer than with a paper-based system. The scheduling features of the software are a distinct advantage, because the schedule is shared; everyone in the office knows the doctor’s schedule, which prevents double-booking and miscommunication. Dr. Bouchard sends his staff members for regular computer training so that all of them can use the computers in the most efficient ways.

The requirements of the Health Information Portability and Accessibility Act (HIPAA) have altered the methods by which information may be used in medical facilities. No employee is allowed to access information in the clinic that is not necessary for that employee to provide patient care and assistance. Dr. Bouchard takes the HIPAA guidelines seriously and makes sure that his entire staff understands the importance of keeping health information secure.

While studying this chapter, think about the following questions:

• How do computers help the physician’s office to run more efficiently?

• Can an employee in the physician’s office invade a patient’s right to privacy by accessing medical records?

• How can information on the computer be kept secure from curious employees who do not need to access the information for the purpose of patient care?

• How does logging in and logging out of the office network help ensure proper access to medical records?

• How could the computer be considered a co-worker in the medical office?

Today’s business world is almost unimaginable without computers, although the computer industry is less than a century old. Within this short time, a computer upsurge has taken place, and today our lives are affected by computers daily. Personal computers (PCs), laptops or notebook computers, and cell phones that send and receive e-mail are commonplace. Our world is now one of enhanced telecommunications, where faster processing of information is both needed and expected. Advances in technology happen daily; as soon as one “new and improved” device is on the market, its “better and faster” competitor is released. Most people venture into cyberspace on a daily basis, where a world of information is waiting with the simple click of a mouse!

Computers are critical in the physician’s office and in other types of healthcare facilities. The development of medically specific software, the decrease in the cost of computer hardware, and the time savings the computer brings to the office make it well worth the investment. A medical assistant must have more than computer literacy; a good understanding of the way computers work and their capabilities is essential in a medical office.

Since the emergence of the electronic medical record (EMR), patients are likely to see physicians using laptops, tablets, smart phones, and/or personal digital assistants (PDAs) in the exam room, an indication that the entire medical industry is steadily moving toward a paperless environment. The EMR makes the physician’s office more efficient and patient information more accessible. The EMR is covered extensively in Chapter 15; before the medical assistant can grasp the concepts of the EMR, he or she needs a strong foundation in basic computer operation. In the current economy, many displaced workers who have found themselves without employment have had to improve their computer skills to be marketable. Some have worked in fields that required little or no computer use, and certainly in any medical facility, computer skills will be mandatory.

Computer Basics

Getting Started

Even with a basic knowledge of a computer’s components and capabilities, without hands-on knowledge the beginner may have some initial fear of the unknown. The most basic setup of a computer system includes a microprocessor, monitor, keyboard, and mouse (Figure 8-1). The computer is only a machine that takes direction from the operator, performing the tasks it is told to do. A computer can simulate the thought process and make decisions, but most computers found in medical facilities wait for commands that prompt it to act. Dialog boxes appear that ask for input from the user; this is how the computer communicates with the user. Computers assist workers in medical offices in several ways, such as:

• Performing repetitive tasks

• Reducing errors

• Speeding up production

• Recalling information on command

• Saving time

• Reducing paperwork and storage space

• Allowing for more creative and productive use of workers’ time

The more familiar medical assistants become with the computer, the better skilled they become in its use. Occasionally errors are made, and the computer may respond with an error message. However, the monitor’s screen normally indicates what to do next. The computer usually allows the operator the opportunity to figure out the correct information and input it. A help menu can always be accessed, or the instruction manual can be consulted; help lines and technical support also are available when problems occur. The problem may be with the software or with the computer itself. Usually, determining which has caused the problem is fairly easy.

Rarely does a computer “break,” although this is a common fear among new users. Records are unlikely to be destroyed by accident; usually, very specific commands are needed to delete stored information. However, a medical assistant must take care not to shut off the computer without saving the information that has been entered. By using a computer in the classroom and practicing at home or at a library, if possible, the medical assistant can become familiar with computer operation and gain confidence that it can be mastered. However, mastery is accomplished only through practice.

With a knowledge of computer terms, the ability to follow step-by-step instructions, and reasonable expertise with a keyboard, a medical assistant can rapidly learn and use almost any computer system. Although computers and software may vary from facility to facility, basic computer operation is similar, and if the instructions given by the computer are carried out, the user should be successful in the tasks attempted.

Although it seems elementary, the first step in computer use is to turn on the system. If nothing happens when the power button is pressed, the primary troubleshooting protocol is to make sure the system is plugged into the power outlet. If a surge protector or an uninterruptible power supply (UPS) is used, be sure this device has power. Then, check all the cords that attach the hardware to determine whether they are fastened securely. Once the power is on, the computer goes through a process called booting. The boot sequence is a set of operations the computer performs to load the operating system and prepare it for use.

Once the computer is on, the desktop appears, along with several icons. To open a certain program, double-click on its icon. Once a program has been opened, many functions can be performed, such as creating a document, a spreadsheet, or a presentation or maintaining a database. Some basic computer functions include:

• Opening a document. A document stored on the computer can be opened by clicking on its icon, if the icon appears on the desktop. If the document is stored in a folder, open the folder and click on the document icon.

• Saving a document. Most toolbars have a button that allows a document to be saved to a folder or to the desktop. Click the button, then name the file so that it can be easily found when it is needed. Word processing programs also usually have a “Save As” option so that a document can be saved and edited without changing the original file. Be sure to check the compatibility of the versions of the software being used. Most programs are backward compatible; for instance, MS Office 2010 can open MS Office 2007, but older software versions cannot open newer versions.

• Creating a folder. Folders in which documents can be stored are easily created. For instance, in a Windows environment, a folder can be created on the desktop. To do this, right-click on the desktop away from other files, folders, and icons, then select the command “New.” When the second dialog box appears, select “Folder.” Click “Folder” and a folder titled “New Folder” will appear on the desktop. To rename it, click twice on the words “New Folder” and type in the words “Study Guides” or whatever title is to be used. The folder is ready for use. To move documents into the folder, click on the document icon and hold the left mouse button down while dragging the document on top of the folder. This is called “drag and drop” or sometimes “click and drag.” To place documents not on the desktop in the folder, use the “Save As” feature and save the document to the desired folder. Or the document can be saved to the desktop, after which the “drag-and-drop” feature can be used to place it in the desired folder.

• Copying, moving, deleting, and renaming files. Most word processing programs allow the user to copy, move, delete, and rename files. In Windows, a file may be copied easily by right-clicking on the document icon and then clicking “Copy.” Then, open the folder to which the file is to be copied, right-click inside the folder, and click “Paste.” A copy of the file will appear in the folder. Files can be moved from one place to another by using the drag-and-drop method. To delete a file, right-click on the document icon and click “Delete.” A dialog box will open that confirms the user’s choice to delete the file. The file remains in the Recycle bin on the desktop for a brief period once deleted; therefore, if a mistake was made and the file is needed, the user should look to see whether it is still available. Renaming files is as simple as clicking twice on the file name and typing in the new one. The user also can right-click on the document icon and select “Rename,” which will allow the user to change the name of the document.

• Cutting, copying, and pasting text. Text can be moved from one place to another by cutting and pasting. First, highlight the text to be moved, then press the “Cut” button. This function can also be accomplished by right-clicking the mouse and selecting “Cut.” Next, place the cursor at the point where the text should be inserted, then click the “Paste” or right-click the mouse and select “Paste.” Text is copied in the same manner. Instead of clicking the “Cut” button, press the “Copy” button. These functions allow the user to be more efficient when creating documents.

• Finding files. Computers have a search mechanism that allows the user to search for a file with certain keywords or extensions. In the Windows environment, click the “Start” button, then click on “Search.” The dialog box that appears asks the user for what to search (e.g., picture, audio file, document, or other file type). An option to search all files and folders also is available. Enter keywords that pertain to the desired file, and click “Search.”

• Copying an entire disk. An entire diskette or compact disk (CD) can be copied. First, click on “Start” and then click on “My Computer.” Find the drive that has the diskette or CD and right-click on that icon. Then, click on “Copy.” Open the folder to which the contents should be copied, and click “Paste.” The actual diskette or CD could also be opened, then under the “Edit” drop-down menu, the user can choose “Select All.” This allows all the files on the diskette or CD to be copied or permanently moved to another location.

• Exiting a program. Click on the “X” button in the upper right corner of the document to exit a program. If the work has not yet been saved, the user is prompted either to save the document or cancel the action. The user also can exit the program by clicking on “File” then “Close.”

When the user has finished with the computer for the day, it always should be shut down properly. To do this, click the “Start” icon, then click “Shut down Computer.” The dialog box that appears allows the user to turn off the computer, restart it, stand by, or cancel the action. The restart function is helpful when the computer “freezes” or fails to function as it should. This takes the computer back through the booting sequence and often corrects problems and allows the user to continue working. Never attempt to fix problems on the computer that are beyond the medical assistant’s scope of knowledge. Often a technical assistance desk can guide the user through various steps to correct basic issues. Always report computer malfunctions to the proper person or department.

Computer systems have user manuals which can usually be easily accessed and referenced online, and can usually be saved to the local computer system or the computer desktop. These manuals can be consulted when functions do not perform as they should or when a user is working with an unfamiliar system. Tutorials may be available to help the new user learn the system or to refresh the skills of the experienced user. Software programs have a help function, usually accessed on the tool bar. The help function allows the user to type in keywords to search for instructions on using certain features or to reference an index of help topics. The help function is written into the program, and users do not pay a fee for its use. However, most of the major software programs, such as Microsoft Office and Adobe Creative Suite, have entire books devoted to details about the use and capabilities of the software, and classes often are available.