 |
       |
|
|
GENERAL PRACTITIONERS’ SECTION
From Apc Days to PC Ways ...Computerization in Medical Practice
Ashok V Khanvte
INTRODUCTION
More than 26 years back, I came to Mumbai, to start my General Practice from Goa where I was pursuing my Surgical Residency Programme. I hardly knew any names of the medicines then. APC was the jewel in my pharmacopoeial crown. From that day till date, so many changes have occurred not only in my thinking processes, but also in the way I have modified a family practice into a diversified General Practice with the modern-PC (Personal Computer) Technology forming the very heart of my set up. Hence the name of this paper -“From APC Days to PC Ways”.
These days it is usual to encounter questions like “Do you have a PC?” “Do you think a PC would be useful?”
May be many amongst us have never used a PC before. But when we discover how today’s easy to use PCs can cut our costs while organizing our practice, we will wonder how we ever got along without a personal computer!
Most physicians are performing quite well as they are - in their clinics, surgeries and laboratories without these PCs, so it is perfectly healthy to be a bit suspicious about these gadgets. So the task before us is to vividly demonstrate the advantages of computerization over the age-old manual office management system.
This treatise shows us that, our own computer can help us do a wide variety of chores from patient record keeping and billings to tracking patient appointments and follow-ups and even writing articles like this, sitting at our desk in the comfort of our own clinic. In short this article highlights how one can be an efficient smart working Doc and not just a hard working doctor.
Why I favour computerization?
Patient information plays the central pivotal role in healthcare management system today. Researchers have concluded that in 38% cases of manual office management systems, no patient information is available when needed. As against this the computerized records afford full and instant availability of patient info, instant access to latest capabilities and share-ability and interoperability of the relevant patient information. The beauty is that all this information can be stored in so little space.
PC Applications in Medical Practice
Now let us look at the ways we can use a PC to enhance our medial practice. PC will help us in:
1. Keeping a track of our patient appointments.
2. Patient follow up and sending appointment Reminders.
3. Patient history and other records are at our fingertips.
4. Patient billing and accounting becoming efficient.
5. Maintaining a durg stock inventory.
6. Storage and prompt Retrieval of patient reports and other information including storage of X-rays, pathology and ECG reports.
7. Instant immunization scheduling.
8. Promptly issuing certificates and receipts and prescriptions.
9. For trend analysis and research.
10. As an efficient finance manager and controller.
11. Patient education and counseling.
12. For continuing medical education programmes (CME) for doctors in their clinics.
13. Correspondence with patients through E-mail and Fax.
14. Make presentations and conduct seminars.
15. Internet applications like-Net banking, bill payment, online purchase, online VSNL connection renewals, etc.
Feeling a bit stressed are you - at the spectrum of activities we could accomplish sitting at our desk? Friends we happen to be in one profession that cries out for computer power. Yet many colleagues have been maintaining an arms length from this wonderful tool-the personal computer (PC). A strange paradox we all would agree.
DISCUSSION
Certainly the computerization of the business aspect of medical practice is very important too. Private medical practices are businesses after all, seeking to supply valuable service for due compensation. One cannot totally separate these two aspects as they are so deeply intertwined. The extent to which these time consuming business aspects of medical practices can be handled more efficiently, physicians are left with more time to devote to patient care. Let us catch the bull by its horns by tackling the questions, which bug us whenever we think of computerizing our practice. I shall answer these questions from the standpoint of my own experience.
1) Do I need a computer in the first place?
If you want to enjoy the benefits already cited then there is hardly any choice but to take the plunge.
Basically you need to find out how much information you are going to process. If you are averse to keeping patient records then there is hardly any point in considering the PC ways. Ask yourself if you have an inordinately large outstanding accounts receivable balance. The following formula is excellent to find out if your manual office management system (OMS) is working at peak efficiency. D=T/R. Here T is the total amount of all outstanding accounts receivable on any given day (use an average), and R is the average amount you bill each day in Rupees. The result D is expressed in days should be between 45 and 90. Lower figures indicate optimum efficiency.
2) How much will I have to invest?
I invested Rs.20,000/- in 1998 in instalments of Rs.5000/- to learn the basics in computerization on a 486 PC. In 1999, I invested another Rs.80,000/- in instalments at zero percent interest to buy a Pentium 3 system with scanner and a CD writer and a colour printer. In 2001 I invested another 25000/- in having another Pentium 3 CPU and establishing a networking between the two terminals.
Most important investment is the TIME factor at least in the initial couple of years and we have to take it in our stride.
3) Will it be cost effective?
I took the decision to invest all this money when I saw that the venture was cost effective and it had started yielding the promised dividends. I have already recovered most of the amount invested in the venture within a span of about 2 years.
I can give the patient reports and records on the same day though I am without a Lab technician, typist and even an assistant doctor for a few months now. My printed stationery expenses have reduced by over 80% as I can even design my letterheads and visit cards on the PC. I have saved tremendously on slides as all my presentations are made on the PC Power point.
If a computer will not pay for itself in three years, it will not be cost effective, since computer systems usually become obsolete in about five years.
4) Will I be able to improve my service?
Earlier if a patient asked for receipt or a medical certificate I would have to call him after 1 or 2 days. But now all I have to do is press just a few keys and there comes a neatly printed document. Patients are highly appreciative of the improved
efficiency.
If an infant is registered under your care, all you have to do is feed the name and birth date of this infant to the PC and within seconds you can give a printout of the personalized immunization schedule to the highly impressed parents.
YES, the service to our patients will certainly be improved.
5) What software to buy?
We must find out what are our requirements. We must write them down and then go about the huge software market to find out which software satisfies most of our requirements. We must find whether the software programme is user friendly and what is the service network of the software provider. Also find out which doctors are using the package and whether they are satisfied with it.
6) What hardware to buy?
I had short listed a software first and then went for a pentium 3 system that had features compatible to run the software at optimum efficiency.
Branded products are reliable but costly. Gray market products may not be as reliable but they are certainly cheaper.
7) How to make transition from manual system to computerization?
This is a very interesting phase. I am going through this transition phase presently. We have to run both the systems in tandem. Depending on the size of our data it could take us anywhere to 1 to 3 years to transit from manual to fully automated practice. We must be prepared to switch over to manual system whenever the PC crashes. Be sure it will.
8) I see one patient every 3 minutes, how can I use a computer? Where is the time?
We have got to do some honest thinking; if we want to improve the quality of our patient records then we will have to find time to feed the data into the PC. Some data in front of the patient and some later. Once we are well versed in the practice management software, it could take us at least 7-10 minutes per patient, to feed the relevant information and write a prescription and even issue a certificate and a receipt to the patient.
With practice we find that using the drag and drop; point and click and cut and paste methods of computers, we save a lot on the time front. Having an efficient data entry operator also saves time.
My Experience
In 1986 I had gone to Dr Jyotiben Ramnikbhai Parekh’s clinic on Peddar Road to see the computer package that she was using then. That is the time I saw how neatly she had kept all her patient records. I learnt my first steps in record keeping and even computer application in practice management from this wonderful person.
My passion for excellence delayed my computerization project by more than a decade. In 1998, I bought a second hand
486 PC with colour monitor, dot matrix printer and a Modem from a friend on easy instalments. The more I worked on this machine the more I was getting convinced about my need for a bigger system and a professional software.
In 1999, as if by divine providence I came in contact with the sales team of a Delhi based software firm that wanted to test
their product in a GP scenario- at no cost. I just had to buy a Pentium 3 from any vendor. I allowed them to load the software on my new P3 system, which I had purchased from the gray market-again on easy instalments at 0% interest. Initially getting used to the task of entering the patient data in front of the patients seemed Herculean. I gave up the dream project twice but I am glad to admit that for more than two full years now, the computerization project is going absolutely smoothly.
Patients are tremendously impressed to see their digital records. The speed with which I can give them their receipts, genuine certificates, reports, immunization schedules, prescriptions and even referrals.
I have been using this software- both for my clinical practice as well as for my diagnostic practice and reporting.
Even interesting X-rays and ECG can be stored on the PC after scanning them.
A few months back I had my first case of Leptospirosis, she was admitted to the Hospital but all the information I wanted on Leptosiprosis, I could get on the net including free advice. Since 1999, all the papers that I have presented at GPA and other medical conferences have been Power Point presentations made on the PC in the comfort of my clinic. Even when I am called on to deliver professional motivational talks or conduct workshops or seminars, they have always been prepared on the PC. For this purpose, I have incorporated CD writer, so that I can write my own CDs for the first aid and stress management seminars, I conduct for my corporate clients. This creates another source of revenue for me and it also pays for the computerization project.
How should one start computerization?
Firstly we must have data worth processing. We must maintain our patient records properly. This is the need of the hour-especially with insurance companies taking over as health care providers. They would certainly want the empanelled doctors to maintain meticulous records. So if one is not maintaining the records, he should start pronto.
Having done this or simultaneously, go in for a second hand PC and learn some basics in computers. Believe me, all that I am doing on PC today is from my urge to learn. No one spoon-fed me with the knowledge.
Next, talk to professional colleagues, who have been using computers, see how effective the software is, its cost and also whether it satisfies your needs. Ensure the service network of the vendor and availability of the upgrades as and when made and their costs. Now upgrade your old system or invest in a bigger system that could launch your software.
Next step is TAKE OFF!!
A Few Words of Caution
Always make back up copies of all your records and other data.
Have a reliable PC Doctor/adviser to maintain your systems regularly and even guide you about updates and up gradations in the system.
Get a good virus shield programme and live-update the programme regularly.
Advantages of computerization:
1. Improved quality of health care service.
2. PC warning on individual patient’s drug allergy while writing his prescription.
3. Confidentiality of patient records.
4. Targeted by insurance companies for empanelment.
5. Practice income increases.
6. Reduction of the avalanche of paper work.
7. Savings on stationery, staff size, storage space for manual records.
8. Recognition of digital records even in medico-legal cases.
9. For research and analysis of the data.
10. Computers are extremely efficient in handling repetitive tasks like billing-both private as well as third party medical insurance billings. They also identity aged receivables.
Disadvantages of computerization:
1. Extra time investment and great effort needed.
2. Financial constraints.
3. Service problems when the hardware/software problem arises.
4. Omnipresent virus attack threat!
5. Paucity of good and economical medical software products.
6. There is no systematic E-education for doctors.
7. Loss of data if one is not careful about the daily backup copies.
8. Staff members entering the patient data, have to be properly trained and should be aware of the confidentiality and medico-legal implications of the responsibility placed on their shoulders.
CONCLUSION
Computers are an aid to improve our service to that most vital person in the healthcare industry- our Patient. With the change of guard taking place in the health care industry, from Doctor oriented practices to a new system where the insurance companies are taking over as health care providers and Patients as the all-important consumers, will target and select doctors who offer them better service. The cutting edge technology of computerization certainly offer us an edge as explicitly depicted in the fore going experiences.
Patients will be happy at the improved quality of service without compromising on time or convenience. It will also help them achieve better health standards through preventive medical practices offered by computerization.
Insurance companies will be happy to have properly documented and easily accessible digital medical records. They will know how their money is being spent and they can keep on monitoring the patient’s health progress.
Doctors too are happy as computerization makes our practice much more glamorous and professionally satisfying by ensuring the orderly and consistent retrieval of recorded patient information on demand. Computerization is financially rewarding as it offers us better practice of medicine.
This leads to a Win-Win situation. Keeping all the parties happy and also leading to a wonderful doctor patient bond of relationship. This is what family practice is all about. Computerization of our practice will ensure that we shall certainly emerge as the rightful winners in this challenging and changing healthcare scenario- all the time practising by choice and not by chance.
If this article has motivated even a few amongst us to think and act in the right direction, then I think I have succeeded in my dream project of taking the road less travelled - From APC days to PC Ways.
MOBILE GROAN
The use of mobile (cell) phones has been banned in UK hospitals since the early 1990s on the grounds that they could interfere with medical equipment. In a Correpondence letter this week, Omer Aziz and colleagues propose a lifting of this ban since no hard evidence has ever proved that mobile phones pose any risk to patients’ safety. Should the ban be lifted?
Lancet, 2003; 2 : 788.
 |