lost on the A-Z folder for mutiple locations, dexis images

For users or potential users.
Post Reply
djanash@mac.com
Posts: 59
Joined: Sat Mar 13, 2010 11:11 am

lost on the A-Z folder for mutiple locations, dexis images

Post by djanash@mac.com » Sat Mar 27, 2010 7:52 pm

I get the databases will be different but I guess another MAJOR limitation is the inability to view xrays from one clinic to the next in case a patient decides to switch or visit a different clinic one particular day...
Is this were log me in comes in

User avatar
drfredc
Posts: 41
Joined: Fri Feb 12, 2010 7:01 pm

Re: lost on the A-Z folder for mutiple locations, dexis images

Post by drfredc » Sun Mar 28, 2010 11:13 am

Seems like this issue is more about needing a central repository for patient data that can be accessed from remote sites.

There's various 'kludge' fixes for this. (A kludge is a workaround which can range from clever, to elegant, to ugly)

Logmein would probably fall in the ugly option, but is also probably the quick and dirty solution. Ugly, because the computer at Clinic B that logmein at Clinic A takes over remotely would be taken over from local users at Clinic B. Optionally, everyone can 'fight' over control of the cursor and keyboard. In theory, one also has to be sure there's no HIPPA violations going on, such as a monitor at the clinic B being accidentally viewed by a random patient while Clinic A views the data via logmein.

Fine print -- You've got to have a computer on at the remote Clinic that has a logmein account that you have access to.
More Fine print -- When using Logmein to view xrays or images, you've got to select a higher resolution display for logmein. For speed, it defaults to a quick and dirty 256 color mode or something like that, which makes viewing xrays, or even the tooth chart, in OD useless.

Another kludge option -- use logmein to email or print xrays from one clinic to another -- the paid version of logmein will allow you to locally print stuff you are viewing remotely... This would allow you to access info at a 'closed' office...

Another "kludge" would be to call Clinic B and ask for them to email the xrays to Clinic A. Takes a few minutes, but it's workable, assuming Clinic B is open...

More elegant solutions might typically involve a common server that all the 'franchised' clinics share over the high speed internet lines. The server could be hosted at one of the clinic sites, or remotely at some reliable secure host. There's security and cost issues involved with any such situation and solution. Assuming these issues are resolved, a shared server would allow any 'franchised' clinic to access any patient's chart, xrays and pictures regardless of which clinic in the franchise chain a patient is seeking treatment from.

How close or far OD is from resolving this sort of stuff for small chain clinics is a reasonable question... I could be wrong, but I recall reading threads where these sorts of issues have been addressed in OD, or are actively being worked on.

I'm also aware, from talking to techies, that there are practical limits to the mysql data structures in larger applications one might encounter with very large chain franchise operations. As I understand it, solutions move into Oracle or other (expensive) database systems (or so Dentrix would have you think). If you've got the chain franchise size to justify the expense, it may be doable. However, OD might require some rework...

User avatar
jordansparks
Site Admin
Posts: 5739
Joined: Sun Jun 17, 2007 3:59 pm
Location: Salem, Oregon
Contact:

Re: lost on the A-Z folder for mutiple locations, dexis images

Post by jordansparks » Sun Mar 28, 2010 8:48 pm

Multiple locations can be on separate databases, but they don't have to be. There are a number of ways to put everything on one database.
http://www.opendental.com/manual/multiplelocations.html

There are advantages to having separate database such as less chance of a single point of failure. If you choose to have separate databases, you can still VPN the locations together. Yes, logmein is one way to get remote access. But there is also terminal services and even direct slower connection to the db at the other office.

I really don't know how dexis handle multiple locations. We are quickly moving towards ftp server instead of shared folder for distributed image handling.
Jordan Sparks, DMD
http://www.opendental.com

User avatar
jordansparks
Site Admin
Posts: 5739
Joined: Sun Jun 17, 2007 3:59 pm
Location: Salem, Oregon
Contact:

Re: lost on the A-Z folder for mutiple locations, dexis images

Post by jordansparks » Sun Mar 28, 2010 8:56 pm

Reply to drfredc:
I don't believe there are any practical limits to the mysql data structure with very large chain operations. Moving to Oracle would not help at all. We have a number of database solutions in place that scale up very well including a web service and replication. What does not scale up very well at the moment is the AtoZ folder. That shared folder is where you have to start dealing with kludges. And, as I mentioned, ftp is the natural choice for replacing the AtoZ folder for muliple locations.
Jordan Sparks, DMD
http://www.opendental.com

djanash@mac.com
Posts: 59
Joined: Sat Mar 13, 2010 11:11 am

Re: lost on the A-Z folder for mutiple locations, dexis images

Post by djanash@mac.com » Sun Mar 28, 2010 10:27 pm

I just so happens that location B is a startup running everything off a laptop with Dexis. Eventually as it grows well have a hardwire system in place but till then importing and exporting xrays by dexis has been a pain. not to mention reworking treatment plans and updates to it. Cant wait till the solution comes around... I think it might be just as things pick up at location B and Im about to pull my hair put of my scalp. time working against me here. the longer it takes the harder it seems the "merger" and conversion will be IMO

User avatar
drfredc
Posts: 41
Joined: Fri Feb 12, 2010 7:01 pm

Re: lost on the A-Z folder for mutiple locations, dexis images

Post by drfredc » Mon Mar 29, 2010 4:04 pm

Caveat -- use the following at your own risk.

Assuming OD can keep everything synchronized between the two offices so you never have conflicts with new patients having the same chart/pt #, there might be a simple solution for keeping your Dexis data up to date -- Just merge the Dexis Data folders of the two offices at the end of the day and then copy the merged folder so each office has a copy of the merged folder... You might even be able to make a batch file process to automate this with a simple click, if you've got a modest DOS background.

Explanation -- when you take a Dexis xray, Dexis stores it as a sequentially #ed .dex file in the folder of the patient #. The Dexis data folder is a large nest of folders. (Ex Data\0\1\3\5\2 folder is patient # 01352's folder.). Also, dexis stores it's xrays pictures in the .tif image file format that are renamed .dex files -- the dex file has some extra info stored in it's 'empty' space for pt name, date, clinic, txt, drawings, etc. As long as OD is keeping things like patient #s straight between the two offices, OD will keep Dexis from getting confused by new patients with identical pt #s and folders. Also you can't be taking xrays of the same patient at both offices on the same day (or before the merge process is done).

Fine print, if you've got 3000 patients with xrays, there are at least 3000 nested folders in your dexis data folder with upteen xray pictures in each folder. Copying and merging dexis data folders is likely to take some time and hard disk thrashing, unless you've got a file management process/application to id the new xrays and their folders so only the new stuff is copied. Perhaps the regular windows copy and paste does this, or not... Perhaps a good backup management app could do this? Perhaps it's not a problem at all...

One could also set things up so at the end of the day the new Dexis images are uploaded and merged to a Dexis data folder on the net, but one also has to deal with encryption and HIPPA security issues with online patient info storage... As far as that goes, carrying a laptop or flash drive around between offices with unencrypted pt info could be a HIPPA risk in some folks minds. It's never as simple as one might wish...

If this all sound like something that might work, I'd check this process out with a couple dummy patients and xray files before actually using it, and checking with OD and Dexis support for their opinions that a simple Dexis merge might solve your problems. Beware, DEXIS tech support might not formally OK this kludge because it's outside of their normal parameters and they don't want to be liable for any messes you might make bending the rules.

End caveat -- use at your own risk.

Post Reply