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Progress is never free, and it isn't all it's cracked up to be.

Fam Pract Manag. 2008;15(1):48

Dr. Brown is a solo family physician living in Mendocino, Calif., and is a contributing editor to Family Practice Management. His “Practice Diary” column, previously published in FPM, is now available on Medscape ( Author disclosure: nothing to disclose.

It's said nothing in life is free. Now I know why. Several months ago, one of my insurance companies offered its physicians “gifts” of either a computer or a personal digital assistant (PDA) to use for improving patient care – the former for online information retrieval and the latter for electronic prescribing. I didn't need a PDA, since I phone in most of my prescriptions. Although I didn't need another computer either, it was hard to pass up. And it came with a laser printer besides. “I'll find something to do with it,” I thought.

What I ultimately decided to do was replace my aging office management hardware with the new machine and my old inkjet printer that grinded out just two pages a minute with the new laser jet that spewed out 20. Yet, I proceeded cautiously. First I checked to make sure that my old practice management software would actually run under the new computer's operating system, and then I moved the program onto my new machine using a zip drive. The switch appeared to go smoothly. The next day, when my office manager used the new system to generate patient statements, she was amazed to see them piling up at the printer in a matter of minutes. With our old printer, we used to have to go to lunch and hope the paper wouldn't jam so there would be a stack of printouts waiting for us when we returned.

Everything seemed to be working the rest of the week as well. The following Monday, as is our custom, we created and successfully sent an electronic claims file for all patients we had seen the preceding week. After my office manager left for the day, I went back online to retrieve our claims acknowledgment report and noticed we had three “suspends,” claims we needed to fix and resend. That wasn't unusual, but in the process of looking up the missing information, I chanced to see that the claim hadn't gotten dated when it was pulled into the electronic claims file. “That's odd,” I thought. The program dates all sent claims so they don't get pulled into subsequent transmissions. I looked at other patient screens; none of the sent claims had been dated!

I was beginning to feel the sense of impending doom that other data may have been damaged as well. Sure enough, some of the claims had simply vanished from the computer. Panic was rapidly setting in. It was akin to the feeling I had as an intern on surgery rotation when, up all night and with 10 patients yet to see, I was sent to evaluate a patient who had thrombosed the arteries in both her legs and was going to die. I felt helpless.

“My practice is going to die!” I mourned, fearing the irretrievable loss of data.

“Get it together,” I chided myself. “You can figure this out. You've trained for this!” What to do? Do what's already worked. So I resurrected my old machine with a Windows 95 operating system, set it beside my new one, restored the week's data onto it and spent the next four hours working off my claims acknowledgement report, going back into patient records, dating claims already sent and recreating office visits on-screen where they had disappeared. All in all, I was glad I had serendipitously caught the problem early, before the task of correcting it had become all but insurmountable.

The next morning, as my office manager and I saw the old program was working, we both exhaled. “Next time I try to fix something that isn't broken,” I said, “please stop me.”


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