Most medical offices use microcomputers (also known as personal computers or desktop computers) linked together to form a network, a collection of computers that can share data and resources (Box 38-1). The number of computers in a network varies based on the size of the medical practice and the type and number of tasks performed on the computer. For example, a two-physician medical office using a practice management program typically has four to eight networked computers. A small network is called a local area network (LAN). In a larger system, the computers in a medical office may be linked to a hospital and possibly other offices. A wide area network (WAN), such as the Internet, is a collection of connected LANs. Networks for large systems usually contain one or more servers, large computers that store data and manage tasks for the computers on the network.

BOX 38-1 Types of Microcomputers

Desktop Computer

A desktop computer, named because it can fit on and under a desk, usually consists of a plastic case containing the CPU (central processing unit), storage devices (e.g., hard disk, DVD/CD-ROM discs), other personal computer (PC) components (e.g., video card, sound card), a monitor, a keyboard, and a mouse.

Workstation

A workstation designates a desktop computer that is more powerful than a typical desktop computer and is normally devoted to one task. The term may also be used to indicate an area for a single worker in an office or laboratory setting.

Laptop Computer

A laptop computer (also called a notebook) usually weighs less than 5 lb and contains the processor, screen, other PC components, storage devices, and a means to input data, all contained in one portable unit.

Tablet Computer

A tablet computer is a complete computer with a touch screen contained in one portable unit. This may be a modified laptop that folds so that the screen faces out.

This section on computer concepts has been designed to provide you with the theoretical foundation necessary to effectively use computers in the medical office. Because the microcomputer is typically used in the medical office, this section focuses on the theory and techniques of microcomputer systems.

Data Processing Cycle

As previously described, computers function by processing data. Data processing is the term applied to changing raw facts or data into an organized, recognizable form. To fully comprehend data processing, it is important to have a thorough understanding of the terms data and program. Data is a general term used to describe the raw, unorganized facts presented to the computer for processing. Patients’ names, addresses, and telephone numbers are examples of data frequently entered into the computer in the medical office.

A program is defined as a set of instructions organized in a logical step-by-step sequence that tells the computer how to perform a specific function. As in cooking, when a recipe is required to tell you how to mix ingredients, a computer requires a program to tell it how to process data.

Computers process data in a logical three-part sequence known as the data processing cycle (Figure 38-1). The data processing cycle includes the following phases: input, processing, and output. Each phase of the data processing cycle involves a specific activity, which is described as follows.

The terms input and output have slightly different meanings depending on how they are used. When referring to the data processing cycle, they are used from the “computer’s point of view” as verbs to describe the transfer of information. Input and output are also used as nouns to describe the data that have been entered into the computer (input) and the information that has been generated by the computer (output). As these terms appear throughout this chapter, you will become familiar with their different meanings.

Input

The input of data is the transfer of data to the computer for processing. Input includes both the entering of data into the computer and the conversion of it into an electronic form that can be understood by the computer. Because computers cannot understand the “written word” in the form used in communication by humans, the data must first be translated into an electronic code that can then be processed by the computer. Once the computer is finished working on the “electronic” data, the result must be converted back into a form that can be understood by the user. A user is defined as the individual using the computer.

Data must be entered into the computer through an input device (see Figure 38-1). The most common examples of input devices are the computer keyboard and the mouse, which are usually used together. They convert data into the electronic code that can be understood and processed very quickly by the computer. Other examples of input devices include a scanner and a microphone.

Highlight on Operating Systems

Almost all of today’s medical office computers run on a Windows operating system. The Windows operating system was designed in the 1980s to mimic the Apple Macintosh operating system (Mac OS) designed for Macintosh computers. An operating system allows interactions between the computer and the user, between the computer and peripheral equipment, and between computer and computer. The interaction may occur using a direct connection, a wireless network, a telephone line, and the Internet. Each time a new operating system is developed, it allows for more complex computer system interactions.

Windows and the Mac OS are based on the concept of the graphical user interface (GUI, pronounced “gooey”). The theory behind this type of operating system is that it operates the way people think—it is intuitive. When the computer is turned on, a desktop appears. The desktop is the computer analogy of all the items needed to open and view programs and files, to perform operations, and to create and store files.

An individual item, such as a patient record, a daily appointment list, or a medical record, is called a file. A file is a set of computer data that has been saved to disk. Files are collected in folders, indicated by an icon of a file folder. Folders can be displayed individually either within a window or on the desktop. When a folder is opened, it appears as a window, and all the files that reside in the folder are in the window. Files can be moved from one folder to another, just as they might be at a desk with papers, folders, and files.

Arranged on the desktop screen are icons. Icons are small graphics that provide a link to files, folders, or applications. With a Windows operating system, these icons include a small computer (My Computer), a recycle bin, and icons for application programs. At the bottom left of the screen is a start button. One click on the start button causes a list of options to rise from it. Many of the options have small arrows pointing to the right; highlighting one of these items causes submenus to appear. By clicking again, an application can be opened.

Application Software

Software designed to allow a user to accomplish a specific task is known as application software, also known as an application program or software program. Application software constitutes the greatest proportion of the software available for use with a computer.

The medical practice management program contains features of four types of application programs: word processing, spreadsheets, telecommunications, and database management. In more detail, these application programs are as follows:

Word processing. Word processing software allows the user to enter, edit, format, and file (store) text. Microsoft Word is an example of a commercially available word processing application program. A medical practice management program can produce letters, statements, receipts, and insurance forms using data from its database.

Spreadsheet. A spreadsheet is an electronic ledger designed to perform mathematic calculations quickly. Spreadsheet programs are used to produce financial reports and to analyze and process statistics. An example of a commercially available spreadsheet application program is Microsoft Excel. A medical practice management program can generate financial reports for the office and revise the data quickly in the same way as a spreadsheet application program.

Telecommunications. A telecommunications application provides the means for one computer to “talk” with another computer. Electronic communication between computers greatly reduces the time it takes to send information. A medical practice management program uses a telecommunications application for the electronic submission of insurance claims. In addition, telecommunications software is used to send letters and messages as electronic mail (e-mail).

Database management. Database management is the storing and retrieving of data in and from a database. Database management allows the user to store large amounts of data on a storage device (e.g., hard disk). The data can then be easily retrieved and manipulated. An example of a commercially available database management software program is Microsoft Access. A medical practice management program performs the majority of the administrative procedures in the medical office using the data in its database. Database management increases efficiency in recordkeeping and eliminates numerous time-consuming repetitive tasks. The database for a medical practice consists of patient records, patient transactions, diagnosis codes, procedure codes, insurance carriers, and so on. This information is stored on the hard disk of the computer or server for later retrieval and use as needed. A database also provides the ability to add new information, modify existing information, and delete unneeded information. The most significant aspect of a database is that the computer can cross-reference all of the information stored in its database. The medical practice database can be thought of as a large pool of information that the computer can access in a multitude of ways according to the task being performed.

Documentation

In the context of computer systems, documentation is a written set of instructions designed to assist the user in understanding how to operate an application program. Clear, concise, and easy-to-understand documentation makes it much easier to learn and use the program. Documentation includes the following: (1) the program user manual, which contains complete instructions for learning and using the program; (2) online help screens displayed on the computer monitor; and (3) reference cards containing frequently needed details for quick reference. It is important to learn to seek out and rely on the documentation that comes with the medical practice management program you are using. This results in more efficient operation of the computer system and less frustration in solving computer problems when they arise.

Putting It All into Practice

My name is Emma Hayes, and I am a certified medical assistant. Since I graduated, I have been working at the main office of an internal medicine practice. Our office manager is very interested in computers, and we have been using integrated practice management and EMR software for the past 4 years. When a new patient calls for an appointment, we obtain all his or her personal and insurance information and enter it into the computer during that first conversation. When patients first come to the office, we have them sit at a computer terminal in a private room next to the waiting room and enter their medical history. If the patient is not comfortable with the computer, we have the patient complete a paper form, and then I enter the data from the form into the computer. We have a scanner at the front desk to scan the patients’ insurance cards and all the forms they sign at the first visit. We keep a folder for our patients with forms that they have signed, but everything is also available in electronic form.

One of the things our patients really like is that our physicians send all prescriptions to the pharmacy electronically. At the first visit, we ask patients for the name, address, and telephone number of the pharmacy they want to use. Some patients like to get their prescriptions by mail order, and we can also indicate that. I also ask the patient what medications he or she taking and enter them into the computer. After that, the physician can go to the patient’s EMR, enter the information about the medication he wants to prescribe, and automatically send the prescription directly to the patient’s pharmacy. The EMR program checks for drug interactions with all the medications that the patient is taking. Our physicians believe that this saves time and is actually more accurate, because the pharmacist doesn’t have to read their handwritten prescriptions.

Hardware

Hardware is the term for the physical equipment making up the computer system—that is, the tangible computer parts. Although a computer system may include a variety of hardware, the following hardware devices are necessary to perform administrative procedures in the medical office: main computer unit, monitor, computer keyboard and mouse, and printer.

Main Computer Unit

The main computer unit, or simply the main unit, consists of a hard plastic case that is usually rectangular in shape. The main unit houses all the components that make the computer work and consists of the following components: mainboard, central processing unit (CPU), main computer memory (RAM), video card, sound card, power supply, and storage devices. The components of the main computer unit are discussed next.

Mainboard

The mainboard (also known as the “motherboard”) is the primary circuit board of the main computer unit. Each of the other components of the main computer unit either sits on the mainboard itself (e.g., CPU) or is connected to it in some way (e.g., hard disk). Electrical circuits the width of human hairs are etched onto the mainboard; the electrical impulses that carry messages to and from the computer travel through these circuits. The mainboard provides a means for all of the components making up the main unit to communicate with one another and can be thought of as the nervous system of the computer.

Central Processing Unit

The central processing unit (CPU) is the functional core or “brain” of the computer and is the most complex computer component. The CPU interprets and executes the instructions that operate the computer. The CPU consists of a microprocessor chip, and therefore the CPU is often referred to as a microprocessor. The CPU resides on the mainboard housed in the main unit of the computer. More so than any other computer component, the CPU determines how fast a computer can process information. The speed of the CPU is expressed in gigahertz (abbreviated GHz), and the higher the value, the faster the computer. For example, a computer with a 3-GHz microprocessor chip can process information approximately twice as fast as a computer with a 1.5-GHz chip. The power of the CPU is determined by the number of bits it contains. A bit is the smallest amount of computer storage. Modern computers usually have at least 32-bit microprocessors, and 64-bit microprocessors are commonly found in servers and more powerful computers. Examples of manufacturers of these microprocessor chips are Intel and AMD.

Main Computer Memory

Main computer memory (or simply main memory) consists of computer chips mounted on a small board that connects the mainboard. Main memory is responsible for temporarily storing information until ready for use by the CPU. Main memory can be likened to a holding tank for the CPU in which items are placed for immediate access and for use when needed for processing. Among those items commonly held in main memory are the operating system, the application program in current use, data waiting to be processed, and information ready for output.

In a microcomputer, main computer memory has a special name: random-access memory (RAM).

RAM is the acronym for random-access memory and, as you have just learned, is the main memory of a microcomputer. It is called random access because the computer can get to any part of the information stored in its memory directly, rather than having to look through all the rest of its stored information. This is in contrast to sequential-access memory, in which all stored data must be searched sequentially from beginning to end to locate the desired information. Much less time is involved in locating information using random access, and it is one of the factors that allows computers to perform tasks very quickly.

As previously described, the purpose of RAM is to temporarily store items until they are needed by the computer. When you first turn on the computer, RAM is empty; therefore you must first place the items you want to work with in RAM. A copy of the application program is transferred into RAM from the hard disk (by using the mouse to click on the appropriate program icon on the desktop of the computer). Data are transferred into RAM through an input device, such as a keyboard. To run the application program, a copy of the operating system needs to be transferred from the hard disk into RAM; this is accomplished automatically by the computer when you turn on the computer. Once these items are in RAM, they are easily accessible and can be quickly retrieved when needed by the CPU for processing. After the data have been processed according to the instructions in the program, the resulting usable information is then placed back in RAM for temporary storage.

One very important aspect of RAM is that it provides only temporary storage, not permanent storage. When the computer is turned off, all of the items stored in RAM are “dumped out”; in other words, RAM will be empty when the computer is turned back on and therefore ready to accept more storage items. Because of this, you must be sure to permanently store information that you do not want to lose before turning off the computer. In the medical office, this information is either stored on the hard disk of the computer or on the server by way of the network. Other common storage devices include Universal Serial Bus (USB) flash drives and optical disc drives, which are described later in this chapter.

Storage Capacity

Storage capacity (the amount of information that can be stored) is measured in units of storage known as bytes. One byte, usually 8 bits, is approximately equal to one character, such as a letter or number. Stating the capacity of RAM in bytes, however, results in astronomically high numbers. Therefore it is more convenient to use larger units, such as kilobytes, megabytes, gigabytes, and terabytes. A kilobyte (KB) is equal to 1024 bytes, which is usually rounded off to 1000 bytes. A megabyte (MB) is equal to a little more than 1 million bytes; in terms of kilobytes, 1 MB is equal to 1000 KB. An even larger measure than a megabyte is a gigabyte (GB); 1 GB is equal to 1 billion bytes or 1000 MB. The largest measure in current use is a terabyte (TB); 1 TB is equal to 1 trillion bytes or 1000 GB.

As you would imagine, the larger the capacity of RAM, the more information it can hold at one time. For example, a computer with 2 GB of RAM has the ability to hold more than 2 billion bytes. Most microcomputers now come with a main memory of 2 GB or more.

The capacity of a computer’s memory (RAM) correlates directly with the level of complexity of the programs it can run. A program takes up a certain amount of space in RAM. A small and simple application program that performs a limited number of tasks occupies much less space in RAM than a large, complex, and powerful program that performs numerous complicated tasks, such as a medical practice management program. The capacity of RAM is an important criterion to consider when working with or purchasing a computer or an application program. A computer with less than the required memory for a particular program would not have enough storage space to hold that program. Hence, that program could not be run on that particular computer. The packaging of the application program is labeled with information on computer system requirements. System requirements tell you what requirements your computer system must have (e.g., type of operating system, microprocessor speed, amount of memory, hard disk space) in order to run the program. Storage devices will be discussed later in the chapter.

Other Personal Computer Components

Sound Card and Video Card

The video card (also known as a graphics card) connects to the mainboard through a video card slot. A video card converts video output into electronic signals. These electronic signals are then sent to the monitor, where they are converted into text and images that are displayed on the screen of the monitor. The sound card is a small circuit board that is connected to the mainboard. A sound card converts audio output into electronic signals. The electronic signals are then sent to speakers that convert them into sound, such as sound effects, music, and narration.

Power Supply

The power supply provides the power needed by the computer to run itself.

Care and Maintenance of the Main Computer Unit

The main computer unit should be placed on a flat, stable surface, such as a computer desk. This prevents excessive vibration during operation, which could loosen the electronic circuit boards. If the main unit is found in a tower, it is designed to be placed in a vertical position. Information on proper positioning is always indicated in the instruction manual accompanying the computer. Laptops should also be placed on a flat, stable surface if possible, and they should be lifted by the base, not the screen.

Computers operate best in a moderately cool temperature environment. Extreme heat and inadequate ventilation increase the chance of malfunction. As a precautionary measure, the main unit should not be placed near a window or other areas that receive direct sunlight. In addition, to prevent overheating, the ventilation slots on the main unit should not be obstructed.

The primary cause of improper functioning of the computer is exposure to environmental contaminants, such as dust, dirt, and smoke. For this reason, rooms with computers should be kept clean with no smoking permitted. The casing of the main unit should be periodically wiped with a slightly damp, lint-free cloth to remove dust and dirt. Aerosol sprays, solvents, and abrasives should never be used to clean the casing because they can damage the finish. The interior of the main computer unit should be cleaned occasionally according to the instructions outlined in the computer’s user manual.

Liquids should be kept away from the computer. A liquid spilled into the main unit can cause irreparable damage to the electronic circuit boards. In addition, an electrical short may occur and could result in a fire or small explosion.

The main unit is attached by cables to the other computer components (e.g., monitor, keyboard, printer). The cables should be checked on a regular basis to be sure that they are secure. A loose or disengaged cable can result in temporary malfunctioning of the computer system.

Computer Monitor

A computer monitor is a piece of electrical equipment that displays images generated by a computer. The monitor permits the user to view both input, or more specifically, the data entered into the computer, and output, or the information produced by the computer as a result of processing.

Viewing the input displayed on the monitor allows the user to check the data for accuracy as it is entered. As an output device, the monitor is often used to review information that needs to be viewed briefly and for which a printed copy (hard copy) is not necessary. For example, if a patient calls your office to inquire when his next appointment is scheduled, you can quickly call up this information, view it on the display screen, and relay it to the patient.

Types of Monitors

Modern liquid-crystal display (LCD) flat panel monitors (Figure 38-3) are small, lightweight, and compact and therefore take up much less desk space than traditional monitors (cathode-ray tube [CRT] monitors) which were bulkier because they used a cathode ray tube. LCD monitors consume very little power and are therefore very energy efficient. An LCD monitor creates a visual image on the screen by manipulating light within a layer of liquid crystal cells. With an LCD monitor, it is sometimes difficult to view the image on the screen from an angle