Archive for Wednesday, November 4, 2009

Doctors take varying approaches to file-keeping

November 4, 2009

Editor’s Note: This is the second in a three-part series on electronic medical records. To read additional stories from this series, look for them on our Web site,

Two longtime family physicians allow a peek inside their clinics to see how they handle patient information.

Their systems are different — like night and day. But they share a common goal: to provide the best care for their patients.

Dr. Stevens maintains paper system

Click. Click. Clickety-click. Click. Click. Click.

Diane Murry, a medical assistant, is using an electronic typewriter to fill out health insurance forms.

Next to the typewriter are two thick organizers. One is used to schedule appointments. The other keeps track of patients’ visits and payments.

Murry works inside the Tonganoxie office of 82-year-old Dr. Philip L. Stevens. The office is in a small building next to the police department and across from a funeral home. It has two examinations rooms, a waiting room and an office area.

Stevens said the office hasn’t changed much since he began practicing there 54 years ago — not even his workload. He said he took care of 27 patients on his first day of practice, and he still sees about the same number of patients, if not more.

“I just take care of people and that’s the way I’ve always done it,” he said.

And, he doesn’t plan to change.

“I am electronically challenged,” he said, laughing. “We don’t do any electronic stuff at all. We have no fax, no computers. We have an electric typewriter. That’s our only concession to modernity.”

Stevens keeps patient records on 5--by-8-inch index cards, and he only uses a black pen. If lab results come in and they are too big to fit into files, they shrink them down by using a copy machine.

“If anybody needs specialized testing, we’ve just got this list of specialists available,” he said as he pulled out a worn sheet of paper from an examination room drawer. It’s filled — front and back — with names and numbers.

Stevens gets the latest medical information through publications such as the weekly Journal of the American Medical Association.

“I didn’t grow up with computers, but somebody who did probably would be more comfortable with them,” he said. “When I first came here, hardly anybody had medical insurance, and I would come down on Sunday and I would do one or two forms and that was it for the week. Now, virtually everybody has it. We turn on our typewriter in the morning and turn it off at night.”

A couple times a day, he dictates information to one of his three medical assistants, and they put it into the medical records using a black pen.

“My writing is not that good,” he said. “They do most of the writing, and it’s very legible, and we can retrieve something in just seconds.”

Murry, of Leavenworth, said she has worked for Stevens for 15 years.

“I don’t have a computer and don’t really care to have one. I am just kind of like Doc. I like things to stay the same,” she said.

Tonganoxie resident Barbara Hardisty described the office system as efficient.

“Since I’ve been doing it for 30 years, it is what I am accustomed to and it works for us. We are really efficient and get it all out.”

She said that a few weeks ago they received 300 doses of seasonal flu vaccine. Within 10 days, they had administered all of the doses, on top of handling Stevens’ regular patient load. That included typing insurance forms and mailing them.

“Here, I do an insurance form and I have paper in my hand because I tear it apart and I mail them the original and I have the carbon and those are things that I have in my hand,” Hardisty said. “I don’t understand the computer world quite as much. I can type on the form and hit send, but then what do I have?”

The office will make advance appointments, but most patients don’t call until the day they want to see the doctor.

“When we get here in the morning, you had better believe the phone is ringing,” Hardisty said.

Then, they schedule the day’s appointments and still accept walk-ins. “If somebody needs to get in because they are sick, we get them in anyway.”

And that’s what patients like about Stevens; he makes himself available whether it is taking a phone call or squeezing in an office visit.

“He’s more of a hometown doctor, and I prefer it that way,” said Bobbie McManus, of Leavenworth. “It’s more personal. If I am sick, I like being able to call and speak with the doctor, and this doctor always makes time.”

In September, Stevens stopped working Saturdays.

“I worked 2,500 Saturdays and I thought that was enough. It’s sort of strange having two days in a row off,” he said.

Stevens and his wife, Betty, have six children, 12 grandchildren and two great-grandchildren. He doesn’t have a cell phone, but his wife does.

“It’s real useful when we are out,” he said. “If somebody wants to contact us and we are out of town, they can call her.”

But, Stevens chuckled and said he doesn’t even know how to turn it on.

One of his children, Philip D. Stevens, is an emergency room doctor at Stormont-Vail Health Care in Topeka. Stevens said he recently toured the ER with his son, who showed him some of the latest technology.

“It was amazing. It was like something from ‘Star Wars,’” he said.

Despite the Internet Age, Stevens said he would stick with his tried-and-true system.

“I plan to practice as long as I can. Somebody asked me yesterday and I said, ‘Well when you see my name in the window across the street,” he chuckled, referring to the funeral home.

Dr. Bruner embraces high-tech system

Using a stylus, Dr. Steven Bruner can open a patient’s medical records and look at them on a tablet computer.

Within seconds, he can pull up a patient’s medical history, office visits, medications and lab results.

“I am a better doctor,” said Bruner, 63, who practices at Lawrence Family Medicine & Obstetrics in west Lawrence, and he credits the office’s electronic medical record system, which was implemented more than six years ago.

He recalled transferring the medical history of his longtime patients into the new system. The process proved eye-opening.

“I would be sitting in there with a chart, kind of thumbing back and forth trying to get the information from the old chart to put in the new chart,” he said. “When you do that, you realize how inaccurate things like problem lists were and all of the past history, like a surgery, didn’t get on because it was all done manually. So, it was just never up-to-date.”

Bruner said the current system updates the record automatically and is accurate.

“It’s a much, much better record,” he said.

The high-tech system alerts him to potential problems.

Take, for example, the patient given a 90-day prescription for high blood pressure medication. After 90 days, the prescription turns a different color in the computer system, which indicates to Bruner that either the patient didn’t return for a refill or the patient has skipped doses.

“So, it’s an automatic check on compliance on medication taking. You just can’t do that with a paper record,” he said. “Also, when I write a prescription, it checks against all of the other prescriptions for interactions and against allergies.”

He also likes what he calls a “rules engine.” The engine allows him to set rules such as every woman older than 50 should have a mammogram, everyone older than 50 should have a colonoscopy, and everyone should have a tetanus shot every 10 years. When each patient comes in, it will search his rules to see if the patient needs to have something done. It serves as reminder for him and the patient.

Bruner said the reason his office moved to the electronic system is because the paper system was getting too expensive to maintain. There are five other doctors in the practice and each doctor sees about 25 patients per day. He said the office was paying about $6,000 a month in transcription costs.

The system cost about $150,000 and they financed it. The monthly payments were roughly $3,500, so they immediately started saving money.

Bruner said he received training in Texas and then trained his 25-member staff. Since then, everything has been done electronically. Every examination room has a desktop computer that doctors use to access and enter information.

“I have read so many horror stories about how much trouble people have had in making the transition to these things, but we just didn’t see it,” he said. “Nobody had trouble, and none of us were techies or anything. We were just regular people that used computers and word processing and searched the Web and things like that and that was about it. It was quite an easy transition.”

He said the system is more secure than the paper files that could be picked up or misplaced.

Bruner said there is a hierarchy of access built into the system for staff members, so office personnel can’t access the same information that nurses can and vice versa.

Soon, the doctors will be sending prescriptions to pharmacies via computer instead of calling, faxing or writing one. The software has been paid for and they are just waiting for it to be installed.

In two years, Bruner said, he hoped to offer a “patient portal” that would allow patients to do certain tasks through secured e-mail communication.

Such tasks would include accessing parts of their records, scheduling appointments, reviewing lab results and receiving reminders about scheduling a mammogram or refilling a prescription. He said offering a patient portal would cost about $7,000 annually.

“Right now, we don’t see the utility of it to the point that we are willing to pay that kind of cost,” he said.

Some doctors are charging patients a fee for those services.

Lawrence resident Nancy Brune, 62, who was waiting to see Bruner last week, said she likes having a high-tech doctor.

“When I get my refill, I don’t contact the doctor’s office at all,” she said. “It’s pretty convenient.”

She is looking forward to being able to access information such as lab results on a computer.

“That would be great because sometimes they tell me my labs, but I forget or I lose the piece of paper,” she said.

The Lawrence medical office’s electronic system isn’t connected to ones at other clinics or at hospitals, but has the capability to share basic health information. That’s a common problem nationwide because most systems are different and such connectivity requires cooperation from all parties.

Brune looks forward to the day when there is a national exchange of health information.

“If you are out of state and have a medical situation and they could just go online and get your records, that would be great rather than having to sit there and tell them your medical history. It would already be in there,” she said.

Lucky for her, Bruner is ahead of the curve when it comes to technology.

The doctor, who has been practicing in Lawrence since 1976, is a self-described Internet addict.

“I probably spend more time in front of the computer on the Internet than I do in front of the TV set,” he said, laughing.


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