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519 W Carson St. Ste. 101 Carson Ca 90745
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C.M.Wilkerson, D.C.

October 99


Communication isnít the only thing, it is everything. This is especially true in the health field, where life and death, sickness and health, can be contingent on communication or lack of it. Whether it is the emergency room of a hospital, or a simple patient encounter in the office, communication is paramount.

Any decision a person makes is based on experience. That is to say, input and output. We are all living breathing biomechanical computers. A computer by definition is a programmable electronic device designed for performing prescribed operations on data at high speed, especially with or linked to other devices for inputting, storing, retrieving, and displaying the data. The way I see it, humans are simply animate computers. The next logical step is to be the best computer we can be.

I decided to become logical and computerize my office in 1981. Why did I computerize, the answer is simple. The darn box could think faster and better than I can! I decided that based on this premise I could keep better records and am able to access and manipulate those records with greater ease.

Need for Documentation

A revolution in health care is by all accounts long overdue. Consider the exhaustive paperwork and complexity involved in staying well in the U.S. Not even the Clinton Administrationís 1996 commission on health care could vault over the massive obstacles posed by consolidating insurance companies, managed health care initiatives and Medicare regulation.

As the demands for more and more documentation mounted, I felt overwhelmed. I would see a patient and take notes, (time) then examine them and write more notes, (time) I would walk out of the exam room and immediately be bombarded with other details of running a practice. By the end of the day, I had 2 hours of paper work yet to be completed. (time patients don't see me spending in their behalf) Shuffling through my notes (time) I try to read if the neck pain was associated with spasm on the left or the right. I then dictate or type up a report that has to be reviewed and double-checked with the notes, X-rays and other findings. Usually, I would end up taking work home, not an enviable choice with a wife and 4 young children.

Once completed the records are saved in a database for later retrieval at any time. As the database is also stored on my pen based portable laptop computer I am able to carry my patient records with me to from room to room, another office and even home.

My computers also have FAX/Modems so the records may be sent to the insurance, attorneys, hospitals, and other physicians immediately.

Without a doubt, both the healthcare community and the individual doctors practice management needs are changing. The demands on the individual practitioner emanate from all directions including patient records, claims submission, data control, fee analysis and litigation. Documentation is more important than ever in todayís climate. One good thing about managed care is that it forces the doctor to document his findings. But whether it is managed care, personal injury, workers compensation or private insurance, a doctor should document. Even a strictly cash patient practice needs to document to avoid litigation. Sooner or later, every practicing physician will have to be capable of efficient electronic data management within and beyond his or her office. Data management is essential for production, acceptability, profitability and growth.

But how do you document in the treatment room when your computer is in your office? Either put a desktop computer, keyboard, monitor and mouse in each treatment room, or carry the computer with you. With desktop prices plummeting, having a full fledge desktop workstation in each treatment room is becoming more viable. However, I think that the ideal situation is to carry a single computer to each patient encounter.

The Portable/Mobile Computer: What kind? Which one?

Albert Einstein (1879-1955) said "Make things as simple as possible and no simpler."

Ideally, I would like this computer to be as light and simple as possible, color, pen capable with a keyboard, and networked to the main server computer with a wireless network card. This same handheld computer would be able to run Windows98 or Windows2000 formerly NT. This would ensure that I could run my favorite Office Suite of applications, which includes Microsoft Word, Access and Outlook98. I mention Outlook, because I can use Outlook to send email to the front desk, billing desk or any computer station in the office. Simultaneously, I can receive email communication from the front desk, while with the patient. I can even make appointments and even do billing right from my notebook depending on the software that I use. In an ideal world, I would use one software package for all accounts receivable, appointments, notes and reports. All reports and SOAP notes could be executed at the time of the patient encounter, to be printed now or later.

Now for reality: In my office, I use MBA (www.mbanet.com) for accounts receivable and appointments, and Auto-Doc (www.auto-doc.com) for SOAPS and reports.

As of this writing, I am using an Orasis pen notebook www.dauphintech.com/orasis.html) and a Palm Pilot Organizer. There are many other units on the market, literally more than a dozen. (www.pencomputing.com www.mobilecomputing.com).

When choosing a computer, make sure you have the software that you want to use before buying the computer. Some software is written only for specific computers. The difference between the Orasis and the Pilot is compromise. Without getting into specifics of each unit, the Orasis advantage is that there is no uploading and downloading of data. The entire software package is on the computer. With the Pilot, uploading and downloading of "active patients," is required on a daily basis. The Pilot fits in your pocket but is hard to see due to the small LCD screen. The Orasis is just over 4 pounds and while easier to see the 7.5" color screen, you certainly cannot put it in your pocket. As of December 15, 1998, there is a Windows CE device called the Vadem Clio (www.vadem.com), which sounds like yet another compromise. However, this compromise sounds like the best so far. The Clio is a pen CE device which is a combination of the Pilot and the Orasis in the sense that it has a large color screen and a keyboard, and is just 3lbs! Almost perfect for healthcare documentation. However, even this unit will require uploading and downloading to a desktop, as it is not a full-fledged computer capable of directly running Windows applications.

The bottom line is that whatever device you employ you will improve productivity and clinical competency if you use the computer. "If" is the operative word. With anything learned there is a learning curve. With the software that I use, the curve is fast and production follows.

Either unit can document treatment protocols, eliminate unnecessary paperwork, and improve patient record accuracy. Plus, you will improve your time spent with each patient. This virtual charting tool enables healthcare providers to capture and access every element of critical patient information at the point-of-care, and output legible clinical soap notes, prescriptions and reports.

Typical Day:

I can either carry a 5 pound color Orasis with a 7.5Ē screen or a 9 oz. Gray scale LCD, Palm V.I prefer the Palm at least for the moment.

The following is a typical day in my office while mobile computing. When a patient makes an appointment by phone they are put into our multi-appointment Calendar, which resides in MBA software www.mbanet.com, which is at the front desk computer. When the patient actually enters the office, they are greeted by the front desk and taken back to another more private room with another computer that has all the patient information with regard to insurance and billing. The patient does not fill out any paperwork, because the secretary asks her all the questions and types it in the screen in front of the patient. This screen is later printed for a hardcopy in the patient record folder. Next this same computer opens Auto-doc www.auto-doc.com, a program that charts patient SOAPS and forms. The patientís chief complaints and history of injury is taken here in less than 2 minutes. A template of signs and symptoms is chosen based on having the patient physically touch the area that hurts them (revised by doctor). The patient is then taken into the examination room. In the meantime, I have downloaded the results of Auto-doc onto my Palm Pilot computer, as well as all patients to be seen for the day. If the patient is not on my Pilot, (no download), then I pull up a template and put the patient on the Pilot in about 5 seconds. If the patient has a return visit as most chiropractic patients do, all the pertinent clinical information is in the palm of my hand. I only need to change what is different. With Auto-doc, this is simply 2-4 clicks of a pen, which may take up to 5 seconds! The only caveat here is remembering the patientís name so you can chart the patient in the Pilot. My favorite line, if I forget their name is "How do you spell your last name?" Another alternative in the interim is to have the patient carry a travel card with their name on it. (with a wireless network card in the Orasis or similar handheld computer, the calendar can be accessed as well as email and all applications, which reside on the main server computer). At the end of the day, I simply upload my Pilot data back to where it came from on the server computer. I do this upload from my office, which is networked, to the server at the front desk. Any SOAP notes or reports can be generated from any computer in the office based on what has been done. Auto-Doc can produce soap notes as well as Workman Compensation and Personal Injury reports as well as many HMO and insurance reports.

The bottom line for me: Mobile computing means less stress and better patient documentation. This translates to better patient care and financial re-imbursement.

Please feel free to email me with any questions or comments. If you canít email meÖÖÖ you better get a computer and go mobile.




C.M.Wilkerson, D.C.