Computer Consult: I'd rather give up ATMs

June 7, 2002

At the push of a button, this doctor can instantly access hospital data and exchange notes with colleagues.

 

Computer Consult

I'd rather give up ATMs

Jump to:Choose article section... Choosing clinical messaging over a conventional EMR A way to save money and manage time better

At the push of a button, this doctor can instantly access hospital data and exchange notes with colleagues.

Cliff A. Robertson, MD

Imagine your life without an ATM card. You'd be standing in line in the bank at lunchtime to make simple deposits and withdrawals. I have equal difficulty imagining my life without my group's electronic clinical messaging system, which streamlines many of the mundane tasks involved in my practice.

The Web-based system, Elysium from a company called Axolotl, takes the place of my office in-box. Our hospital gives us lab and radiology results online, as well as all dictated reports, including operative notes, H&P notes, and discharge summaries. Before we got this system 18 months ago, either I wouldn't see the discharge summary, or it would turn up in my in-box three weeks after it was dictated; until then, I'd often have no concrete proof that my patient had been in the hospital.

Besides inpatient data, the messaging system gives me online results for all the outpatient labs I order from the hospital. Along with 20 of my colleagues in the Franciscan Medical Group, I include all of my transcribed notes from office visits in the online record.

The system also comes in handy when I refer patients to specialists. Instead of dictating a cover letter and having my nurse copy several dog-eared pages of notes and mail them to another doctor, I can push a couple of buttons on my computer and send the notes as an attachment to a secure message. Or the computer will send the pages directly to the specialist's fax machine.

Being able to obtain results online also allows me to address patients' concerns in a more timely manner. For example, a mother phoned me one night when I was on call. She was upset because her daughter, who had a sore throat, had been seen in a clinic that afternoon but hadn't been given a prescription for an antibiotic. With just a few clicks of my mouse, I logged on to our system, saw that the rapid strep test done by my partner had been negative, and confirmed that the diagnosis and treatment were appropriate for her child. I was able to put a worried parent's mind to rest quickly instead of making multiple calls to retrieve the test result.

Choosing clinical messaging over a conventional EMR

Converting to a conventional electronic medical record could have solved some of our workflow problems. But we felt it would be too time-consuming, disruptive, and expensive. We also wanted the primary care physicians in the group to be able to exchange data with the specialists to whom they refer without having to wait until everyone was using the same EMR—a practical impossibility.

With our new messaging system, we can reap the benefits of electronic information without abandoning paper charts. And it lets our diverse population of independent physicians enter the online world at their own pace.

After signing a contract with Axolotl, Franciscan Health System, our parent corporation, transferred the Elysium license to our PHO, which does our managed care contracting. Half-owned by 600 area physicians, the PHO had already prevailed upon its members to use an online authorization system for referrals. While it hasn't been easy to persuade the community doctors to go online for clinical messaging, too, some of them have begun using Elysium, which costs them $40 a month.

The Franciscan Medical Group has 125 Elysium licensees, including nurses, medical record personnel, billing coders, and 51 of our 65 providers, including six midlevel practitioners. Not all of the physicians use the system; but even if they don't, their nurses usually do, because it means they don't have to pull charts for every information request.

A way to save money and manage time better

Every time we have to get a chart out, it costs us about $3. One of our clinics required 1.5 full-time equivalents—at a cost of $50,000 a year—just pulling and refiling charts for patients other than those scheduled for an office visit. But by using our online database, my nurse can immediately give patients their test results when they call. That cuts our medical records expense and eliminates annoying rounds of phone tag.

Savings aside, the system enables me to leave the office sooner. After a day of seeing patients, I no longer have to stay at the clinic to go through lab results. I can go home, spend time with my family, and manage my secure in-box from home after the kids are in bed.

I'm even able to keep up with patients while I'm hundreds of miles away. During my most recent vacation, I logged on each morning from a private terminal in the hotel business center. Reviewing, annotating, and forwarding recent labs took about half an hour.

This confers a twofold benefit: I can give my staff long-distance instructions on patient care, plus I don't have to face a huge stack of documents when I get back. One of my colleagues uses the last day of each vacation to catch up on paperwork before he resumes seeing patients. I prefer to spend that extra day on the slopes with my family.

Some people might complain that the ability to connect to the office 24/7 blurs the line between work and home. But patient needs don't wait for the office to open, and being on call is a fact of life for a doctor. Now that I can manage routine tasks online, I've found that I have more control of my day. I can strike a balance that provides me with more time to enjoy the people and things that matter outside of work.

Return my practice to the paper-only world? I'd rather give up my ATM card.

The author is a family physician in Tacoma, WA.

 

Cliff Robertson. Computer Consult: I'd rather give up ATMs. Medical Economics 2002;11:30.

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