The Year of Going Paperless

Seven months into 2011, things look very different than they did this time last year at my office. Not only have I been using an electronic medical record for nine months now, but I’ve also been submitting claims electronically (through a free clearinghouse) using an online practice management system. I’ve also begun scanning patients’ insurance cards into the computer, as well as converting all the paper insurance Explanation of Benefits (EOBs) into digital form. I’ve even scanned all my office bills and business paperwork and tossed all the actual paper into one big box. As of the first of the year I even stopped generating “daysheets” at the end of work each day. After all, with my new system I can always call up the information I want whenever I need it.

How did such a committed papyrophile get to this point? It is the culmination of a process that actually began last summer with the purchase of an adorable refurbished little desktop scanner from Woot ($79.99, retails for $199, such a deal!) The organizational software is useless for my purposes, but it does generate OCR PDFs, which makes copying and pasting ID numbers from insurance cards into wherever else they need to be a piece of proverbial cake. The first step was to start scanning the office’s administrative paperwork (phone bills, electric, etc), since that didn’t affect the staff’s workflow. Suddenly, instead of having to sort the increasingly teetering piles of paper bills into file folders in an upstairs desk drawer, I had a single file on my computer where I could access any document I needed with a click or two.

Next, I appropriated the insurance EOBs, scanning them into a wireless network-attached terabyte storage device I hooked up. Now instead of rooting through always-misfiled folders, a single click instantly pulls up whatever EOB is needed to confirm for a patient that yes, they really do owe us that balance.

My hand was forced a bit as fall approached when one of my two staffers decided to retire, and I made the difficult decision to not replace her. There was no way I was going to be able to manage the office that way with paper charts, so I was extremely fortunate to share an email exchange with WhiteCoat about a free EMR. When I checked it out, I was thrilled with how intuitive it was. It was chock-full of tutorials and support and whatnot (cheating, to my techie heart), but without watching any of them I was able to get the hang of writing notes, uploading documents, and customizing templates all on my own…and had a whole lot of fun doing it! So once the speeches were done and the gold watch awarded (actually, we all just went out to lunch) we re-tooled the entire office for our new digital systems.

Nine months into it, and it’s still fun.

When a patient calls for an appointment (all scheduling is now electronic, so I don’t have to ask weekend callers to “Please call back Monday morning because I don’t have my book with me”) we pull their paper chart, scan the progress notes and upload them into their electronic chart (everyone in the old practice management system was automatically uploaded when we made the transition, so there’s already a rudimentary file with whatever address and phone number we happened to have). I enter the problem list, meds, and preventive care history (all neatly laid out on the inside front cover of the paper chart), and I’m all set to see the patient.

The other piece of hardware that makes the system hum is the NeatDesk duplex scanner. Same company as the little receipt scanner, same useless software, but makes wicked fast work of a sheaf of double-sided notes.

I procured an adorable little laptop, just a bit bigger than a netbook, with the footprint of a piece of paper, which I take into the exam room with me. I’ve also become quite adept at typing without looking either at my fingers or the screen; that is, I am able to type while maintaining eye contact with the patient. In a way, it’s even more efficient than paper was, since I couldn’t really write without looking; I tried; the results were suboptimal.

Patients don’t mind it. In fact, many of them love it when I print out either the treatment plan or, for all those pediatric well checks, the entire visit note, complete with the height, weight, BMI and so forth.

Lab results come directly into the EMR. Between 80 and 90% of people ask me to email their results, which I love! I don’t have to worry about calling them while they’re driving or otherwise too distracted to follow what I’m saying. If there’s something even a little complicated to explain (“Please start taking 2000 IU of vitamin D every day”) having an email that can be referred back to is wonderful (instead of calling to say, “How much vitamin D? Do I need a prescription for that? What was my level again?”)

The major down side so far is that after keyboarding all day, the last thing I want to do once I get home is boot up again and blog. My new novel also seems permanently stuck at the half-way point. Aside from that, though, as far as the office is concerned: life is great.

I’m not paperless by any means, but I am using far less paper than ever before. The next machine to be tamed is the fax. Once I figure out how to plug its telephone line into a computer to send and receive documents directly, things will be even better.

My staffer and I are flourishing. We miss the other lady, but we’ve settled into a nice, functional rhythm. I’ve even held things together without her. When she goes on vacation, I become a true micropractice. I set a sign up at the front desk to let patients know where I am and that I’ll be right back (and to please get out their insurance card and co-pay while waiting for me), and I use a nifty little computer service (also free) called Google Voice, which allows me to answer the phones with an apology for not taking the call and an invitation to leave a number. I usually return the call within 10 minutes, so no one’s gotten too bent out of shape so far.

As for “meaningful use” and the receipt of actual cash money from the government for this whole EMR thing, I’m actually on track to collect a little something this year (no where near the $44,000 breathlessly advertised; that’s a grand total over 5 years, and you need to bill Medicare at least $25,000 a year to max out; I’ve got well less than half that) but I ain’t holding my breath. Then again, the stated purpose of these funds is to help defray the costs of adopting the EMR. Given that my system is free, at the very least I’m not losing anything.

Bottom line:

The Dinosaur and the Electron: Perfect Together.

Dinosaur MD is a solo-practitioner in Family Medicine. She is also a book author (Declarations of a Dinosaur) and posts frequently at her blog, Musings of a Dinosaur, where this post first appeared.

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5 replies »

  1. Could the perants be acting more as event planners during the summers these days be partly a result of advances in technology? When I was growing up, there was little fear of me becoming as big of a couch potato as I am now, because a Vic20 just didn’t have the variety or vivacity of games that an X-Box 360 or Playstation 3 has. And that’s to say nothing of World of Warcraft. Maybe now perants HAVE to be more proactive so that their kids get to experience the adventures we did when we were growing up?

  2. Patient Information Exchange in the 21st Century

    Health information exchange or (HIE) is the process by which physicians send patient information across geographic areas and institutional systems. HIE is the electronic method used to keep every medical professional involved and updated on every aspect of each patient’s condition. It is like electronic file sharing, though a high tech game of telephone. The system, in theory, provides doctors and patients a great communications tool, and access to even the most remote chances at treatment opportunities.

    The Problems are….
    As with any other technological advantage, there are problems with HIE systems. In fact, these problems are large enough to warrant a closer look.

    The issue of Records
    First, there’s the problem of electronic health records that are being sent over the HIE system. The transference of these files is made by the HIE system, but there is still the problem of what to do with the documents before and after they are transmitted. HIE was created to make the passage of records a smother process, with no regard for the printing, end user, infrastructure, software, applications and practice management issues. Doctors are still stuck with managing the patient files.

    Room for Error
    Computer systems are only as good as the person inputting the data. HIE systems rely on human input, uploads, system performance, data checks (to avoid corruption) and the costs involved in converting and migrating all other systems to be able to interface with the HIE. Even after the changes are made, human hands must check for and properly eradicate the bad data. The interference of human hands into the various points of the HIE system also inserts and increases the chance of human error. Human error is something that no system, including HIE can fix on its own.

    HIE systems are an advanced technology that is also not very cheap. The manpower involved in system integration alone is enough to cause some cash-strapped hospitals and clinics to balk. In many cases in foreign countries, the hospital has little funds to use for operating costs, thus an electronic file system is out of the question. Fortunately, there is a system available to rectify these hindrances to a fully computerized records system. An alternative for doctors!

    SmileMD’s Cloud Backbone system requires no capital expenses. It is a turnkey solution. The Cloud Backbone system is one created with doctors and the demands of their practices in mind. Doctors must share information on patients whenever possible, and the HIE system is the most efficient way to do that. It allows doctors the opportunity to concentrate not on the technological tools used in the practice, but the patients that give the practice purpose.

    Cost Reduction
    The cost is still a concern, but it shouldn’t be. The Cloud Backbone system actually saves clinics and hospitals, and medical and dental practices money. It reduces infrastructure and software costs by forty (40%) percent because additional facilities are not needed. HIE related system repairs due to breakdowns are also reduced by 95 percent, as many of those systems aren’t necessary. They are replaced by the Cloud Backbone and ARRA/Meaningful Use funds are available to customers to help with costs.

    Patient security is always a risk, especially in a process that sends sensitive information over electronic channels. SmileMD Cloud Backbone has the ability to securely work with your data, providing a secure mobile and remote access to the system. The information is backed up hourly so as to avoid any potential loss of data. Corruption is also thoroughly investigated to be sure that the human hands inputting the data were accurate in their data entry. Patients can feel safe knowing that their records are inspected and handled securely. SmileMD even offers a toll free customer care number that links you with live assistance and guaranteed support. In fact, our company guarantees that the system will never go down.

    The SmileMD Cloud Backbone allows for HIE and electronic hospital records to be integrated in one location. The system is also compatible with other software, including PPMS and EMR. This eliminates the need to convert or integrate files before or after they pass through the HIE process.

    The Cloud Backbone makes access to the HIE system much more convenient, facilitating access to the system from any SmileMD registered location. It enables uploading and distribution of records, right down to the filing system. The Cloud Backbone allows any doctor, especially those in rural areas to have access to several patients in that area, not just patients accessing their clinic. This way, one doctor can provide services to multiple locations without the hassle of lugging around patient records. The platform is available worldwide, making access from remote locations possible. There is no need to build out space for the HIE process.

    SmileMD has expanded its physician’s services to include the answer to the HIE dilemma. What you could call the middle man between the HIE system and the physician. The system is advantageous for a number of reasons, the SmileMD backbone matters most to physicians because the current flux in federal EHR format standards is a deviation from what state, local and private insurers are using in their attempt at “nationalizing” the patient database. We adapt ALL patient data to meet current and future specification changes without new technology or capital investments by medical practitioners, because the SmileMD backbone enables integration into all levels of HIE. Healthcare providers with different geographic locations will still benefit, as will their patients because the information will be securely available across county and state lines. Currently, this is not possible with the fragmented HIE rollouts.

  3. Thanks for sharing your experiences of going paperless.

    When you are ready to move forward on the the Fax side of thing take a look at service providers who can send all faxes to you as email and allow you to send faxes from you email account.

    Sometimes it is easier to use a service provider than do it all yourself. eFax is a company I have heard of before but make no recomendation above that. The only thing I would suggest is that you go with a company operating in the same country otherwise you will find faxes being routed internationally.

    Keep up the great work.

  4. “The next machine to be tamed is the fax. Once I figure out how to plug its telephone line into a computer to send and receive documents directly, things will be even better.”

    We gave up on the computer and went to a service like eFax. If you have really high volume UnityFax works great so far.

    With the computer we had problems when the computer would crash or go down. You had to have multiple fax cards if you had multiple numbers or high volume for roll over. Never really found any software we liked either.

    With the online service we never have a busy signal. You can have them emailed as PDFs into your inbox or view them through the software and its easy to fax from your computer.

    We keep the fax machine plugged in for those cases where we need to send paper. We have our local existing fax numbers forwarded to one number at efax or unity, we use both, my personal fax is efax our high volume is unity.

    Are most of your payors not offering electronic EOBs? I can’t get our providers to sign up, it would save me a fortune if they would. They get ACH payment then retireve EOBs from website and most of the time can import them right into their pratice management

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