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    Monday, April 04, 2005

    Where I've Been: Sorry for the prolonged and unannounced absence. Wish I could say I was whisked off unexpectedly to exotic ports, but I've been doing drone work. Switching to an electronic medical record has been more time-consuming than expected.

    Sorting through the patients' paper records and summarizing the important points - last pap smear, mammogram, rectal exam, colonoscopy, and other pertinent past history, adds 1-2 hours to my day. And I've just been doing it as patients come in for appointments rather than a wholesale mass conversion.

    But it's the scanning of current information as it's received that's really taking the toll. I have a small, portable scanner that I can carry home with me. As I review the day's labs, x-ray results, and correspondence, I also scan them into the chart. It's a much slower process than my old pre-EMR way, which was to look them over, put aside the abnormals to have the charts pulled by the staff, sign off on the normals and put those in a pile to be filed away later by the staff. The old way was faster for me, but not necessarily better. With the digital chart, I don't have to wait a for the chart to be pulled (This was often not until the next day, since the only time I have to review results is the end of the day after the staff has gone home). I just pull up the chart on the computer and make my decision then and there. And as far as that stack of filing - too often it went undone. It would pile up for a month at a time, despite my constant admonitions. When they finally got around to filing, they would just stick the papers in the chart thinking that when the patient came in for the next appointment the papers could be placed in the correct slot within the chart. But that often didn't get done, either. I would see a patient and discover lab results and letters just loosely adrift within the chart.

    And although it seems like filing would be an easy task, for some reason, very few people can perform it well. When my staff did take the time to actually file the papers, they often put them in the wrong spots. Correspondence would be in the lab results sections, x-rays would be in correspondence, and just about any combination possible. The only time this wasn't the case was when I worked for a staff-model HMO where we had a full-time filer who took pride in doing a good job. That's not a financially feasible option for a solo physician.

    So, I spend another 1 to 2 hours a day scanning things into the chart. I could hire someone, but it's hard to find someone willing to work just 1 to 2 hours a day. What I need is a free-agent professional scanner who works in several offices - kind of like my cleaning service. But, as with cleaning services, the job may not always be done well.

    So, I spend my time in drone mode scanning. But at least my records are well-organized and current.

    UPDATE: Advice on scanning from various readers:

    There are scanning services who do just this (on their premises however). They will do a significantly better job than you can at a very high level of accuracy. This is possible because they have equipment
    and software which is significantly better than what you've got. They charge by the page (typically $1.00-$2.00 per page depending).

    That's a pretty steep price. I can have anywhere from 30 to over 60 pieces of paper come through my office in any given day. Just this past weekend, some 30 of my patients decided to have their blood work done, for example. And that was just blood work. There were also X-rays and consultant letters and emergency room visits and hospital discharge summaries that came in as well. Such is our obsessive need for documentation that there's no end to the paper that comes through a typical doctor's office. I would take the time to quantify it, but knowing the number would probably depress me.

    And this:

    What is most time-consuming part of scanning documents?

    HP makes a series of products called a Digital Sender. (I know that Xerox has similar products)

    These are basically scanners that can scan quickly, send e-mail (with PDF attachments), save scanned files on a file server and, with the correct software, interface with document-management systems so you can enter a case number and the document will be automagically be filed with that case. I know that many law offices use these machines.

    The most time consuming part is the scanning. I have a scanner, made by Brother, that can send email and faxes and can scan multiple pages at a time. It is only partially compatible with Windows XP Pro, however. Everything works except the document feeder. That only works with older versions of Windows.

    The other problem is the set-up of my EMR software. It requires opening the chart of each patient before scanning in the report. The software company does offer a separate module that allows the direct entry of results from particpating diagnostic laboraties, so it must be possible to do this sort of automatic filing. I just don't have that capability.

    In addition, each piece of paper has to be placed in a proper category. It can't just be scanned into one common spot, but has to be categorized as "lab results," "radiology," "correspondence," etc. I'm sure there are subtleties to my software and hardware that I just haven't learned yet, but for now I'll muddle on.

    posted by Sydney on 4/04/2005 08:03:00 AM 0 comments


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