Fam Pract Manag. 2001 Jun;8(6):52.
Charting with PDAs
Is it possible to do office charting and write clinical notes with a personal digital assistant (PDA)? If so, what software is available?
Yes, you can do charting and write clinical notes on PDAs, such as the Compaq iPAQ Pocket PC (which runs on the Microsoft Windows CE operating system) or the Palm Vx Handheld (which runs on the Palm OS operating system). However, this doesn’t mean you can access all the information of a full-blown, fully paperless, client-server electronic medical record (EMR) from your PDA. Although most EMRs interface with PDAs to some limited degree (the scope of which will probably grow), PDAs currently lack the computing power, memory and screen size necessary for full integration with EMRs.
The charting software products you can use with your PDA range from scaled-down patient-tracking software written specifically for PDAs to full EMR systems that now transfer (or “port”) some elements to a PDA. Here are a couple of examples:
Mobile MedData from Medical Communication Systems Inc. (www.medcomsys.com) offers three levels of charting products. The “Personal Edition” is solely PDA-based and allows users to track patient data and share or print chart notes via infrared beaming; the “Professional Edition” adds connectivity to a desktop computer, enabling users to transfer data to a relational database and integrate their PDAs with their third-party billing and practice management software; and the “Enterprise Edition” adds connectivity to a health information server that allows multiple users to access patient information, capture billing data, get lab results and write prescriptions – all from within the clinic or securely from the Internet.
PocketChart from Data Critical Corp. (www.datacritical.com/index. html) is a stand-alone, Pocket-PC-based “EMR” that lets PDA users gather patient information, write notes and prescriptions and then seamlessly transfer that data to their desktop computers, where they can print notes and capture E/M and charge codes.
For more information about PDAs, including a detailed list of EMRs that use PDAs to some degree, go to www.fphandheld.com.
Part-time call schedules
I’ve recently joined a group and am working half time sharing office space with another half-time physician. The full-time physicians want me to take the same amount of call time as they do. Is this what part-time physicians usually do?
It depends on each physician’s particular situation. I’ve worked varying degrees of part time with varied call arrangements throughout my career, but I’ve usually taken the same amount of call time as the full-time physicians for a number of reasons: I thought the gains in goodwill among my colleagues outweighed a few less call days a year, I realized my colleagues were fielding telephone calls from my patients during the week when I wasn’t there and I was often a senior physician in a large practice.
However, as a new member of the group – presumably just building your practice – you seem to have a different situation. Since you have a colleague who is also working half time, I think it would be a fair and reasonable compromise to suggest that the two of you be considered one physician for the purposes of call rotation. Or, if you do take the same amount of call time as the full-time physicians, you could ask for a compensatory increase in your salary. For example, perhaps you could be paid for working 60 percent of the time rather than 50 percent.
It’s difficult to broach this issue once you’re already working in a practice, but it’s worth it for the sake of your long-term job satisfaction.
Teaching physician rules
Under the primary care exception to the Medicare teaching physician rules, if a billing faculty physician supervises three residents, can he or she also supervise one physician assistant? Also, if two billing physicians are supervising eight residents, can resident A be supervised by billing physician A for one visit in a session but by billing physician B for a different visit in the same session?
The primary care exception to the Medicare teaching physician rules allows physicians to bill for residents’ services without being in the exam room, provided that all requirements of the rule are satisfied. Two requirements relevant to your question are that the teaching physician must direct the care of no more than four residents at a time and must have no other responsibilities at the time of the service for which payment is sought. Supervising a physician assistant and residents at the same time would qualify as another responsibility, thus voiding the primary care exception – even if the number of residents supervised at the time was less than four.
However, the rules don’t require residents to be assigned to a particular teaching physician for the period of the exception. Thus, eight residents with two teaching physicians should meet the four-to-one ratio required by the exception. In your example, teaching physician A and teaching physician B should both be able to bill for separate services provided by a given resident, assuming the teaching physicians meet all the other requirements of the primary care exception.
Copyright © 2001 by the American Academy of Family Physicians.
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