BY TONI LAPP
 In a paperless office, patients such as Frances Lowery enter their own (or their children's) medical history with a click of a mouse. |
It's almost ironic: The computer, tool of professional productivity, is enabling doctors to focus more on personal touch in their practices. Take, for instance, Karen Smith, M.D., who started her Raeford, N.C., family practice in April after years of being part of a hospital-owned practice.
"It was an amazing difference; the lifestyle change was dramatic," she said. "It's more than just monetary."
Having an electronic medical record system has enabled her not only to spend more time with patients, but also to have more of a life outside her practice, she said.
"What about the files?"
When Smith made the decision to hang out her shingle in a solo practice, she already knew many of the benefits of having an EMR system, having done her research. She was determined to go paperless.
"When I left the hospital practice, the senior vice president (of the system) asked, 'What about the files?' He wanted to know if I needed to have full access to paper charts, and out of my mouth came the words, 'No, my records are going to be at my fingertips,'" said Smith. "Then my search began."
She went with A4 Healthmatics®, which she described as "a typical EMR system." It offers an on-site EMR server that interfaces with a Web-based billing program and with the lab, as well as with an instant medical history program that allows patients to enter their own histories on the computer.
Smith's decision to go paperless was helped by a dictation bill of $5,000 one month -- about twice the normal fee. "I basically had to take part of my salary and give it to the transcriptionist," she said.
Enter another benefit of having an EMR system: no transcribing.
Instant documentation
When patients arrive at Smith's office, they check in with a receptionist, the same as they would in any traditional practice. Most similarities end there.
While patients wait to be seen, their insurance information is verified by computer with the insurance provider. Gone are the days when 60-day-old claims that have been denied have to be investigated and resubmitted by office staff, resulting in a loss for her practice, Smith said triumphantly.
Once this information has been verified (or updated, if necessary), the receptionist sends an instant message noting that the patient has arrived. The message appears on a computer at the nurse's station and on Smith's computer in the hallway. "I feel like an air traffic controller sometimes," Smith said recently as she checked the status of her patients in various stages of their visits.
Smith has a computer in each of her seven examination rooms, and patients enter their own histories, using the IMH program. The computer "interviews" the patient about symptoms through an interactive Q and A. It can take anywhere from five minutes to 30 minutes, depending on the types of answers the patient gives, said Smith. The IMH might make "suggestions" for treatment based on the answers.
The end result is that the documentation is done at the moment of the visit.
"Before going electronic, I would get home on Mondays at 11:30 at night," said Smith. "I worked through lunch, reviewing labs, doing dictation, completing home health paperwork, etc. There were times I'd have to go in on Sunday after church to do more documentation, do more reviews. The rest of the week, I was lucky to get home by 8:30 at night." Now she works a much saner schedule -- usually 8 a.m. to 6:30 p.m. -- and is able to spend more time with her husband and four children.
Chart reviews
Karen Smith, M.D., says her EMR system has made a "dramatic" difference in her practice. Her system has interfaces among billing, medical records, lab reports and instant medical history. The latter leads patients through an online interview to document symptoms (see photos at left). |
Just weeks after she reopened the office as a private practice, Smith was the subject of an audit by a private insurer. The company wanted clinical data for its insured patients, a task that would have required many charts to be manually pulled -- had Smith been using a paper system. "It was amazing," she said. "With the push of a few buttons, I was able to have that information in a neat fashion in a few minutes."
Patients' views
Smith's fears that patients might be reluctant to enter their own symptoms into their IMH were laid to rest early on. Even elderly patients who have little technical prowess have a curiosity about the computer and are eager to learn, she found. If patients are unwilling or unable to enter their symptoms into the IMH, a third party can still enter the information. And patients who are hard of hearing no longer have to strain to hear the nurse during history-taking.
"I like it," said Frances Lowery, who recently brought her children in for their appointments with Smith. "I want my kids to be familiar with computers, plus it gives you something to do while waiting for the doctor."
With the information literally at her fingertips, Smith was able to pull up growth charts for Lowery's children and show her where they were on the growth curve.
Smith noted that some things are still foreign to patients. "We've had people waiting patiently in the lobby for their prescriptions," she said. "Then we've had to tell them, 'that was faxed directly.'"
But some things haven't changed, she said. "Patients still want that interaction, like 'how have you been,' or 'I saw you at the store.'
"That will never go away."
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
FP Report is published by the AAFP
News Department.
Copyright © 2003 by
American Academy of Family Physicians.
