Clinic of 50 physicians & 60 Nurses implement e-MDS Solution Series
Doctors, nurses will use wireless Tablet PCs to chart patient progress

Retired anesthesiologist Tom McGranahan showed off the capabilities of wireless-networked Tablet PCs and e-MDs Solution Series in use at Bend's new Volunteers in Medicine Clinic. (Photo by: Barney Lerten)

April 4, 2004 - Once in a while, it seems that the best way to strive for old-fashioned quality is to make use of newfangled technology. That’s being put to the test as never before in the country this week, as the Volunteers in Medicine Clinic of the Cascades starts treating the region’s many uninsured residents, using a wireless, computerized record system that’s more akin to Star Trek Doctor McCoy’s tricorder than ol’ Doc Brown’s stack of files.

After a week of dress rehearsals, eligibility screening and staff training, the 6,200-square-foot VIM Clinic, in the works for about three years, begins treating patients this week. The staff includes almost 50 volunteer doctors, physicians assistants and nurse practitioners, 60 nurses and dozens of pharmacy and lab technicians, working beside hundreds of volunteers from outside the health care community.

Almost two-dozen similar clinics have come into being across the country, but none is as fully computerized as Bend’s facility, according to Doug Ritchie, a retired executive with the chip-maker AMD who came aboard two years ago as IT director.

There’s a logical reason why a brand-new clinic has a leg up, when it comes to embracing technology – unlike existing facilities, there aren’t mountains of old paper files to scan in, or old computer systems to trash or upgrade.

But there’s an equally logical reason why even the least computer-friendly retired doctors are similarly enthused about picking up a Tablet PC attached to a wireless network and doing what they used to do with paper and pen: the need to provide continuity of care in a unique clinic environment, where each patient might see a different doctor for every visit.

It’s the most notable example on the High Desert of a growing issue in health care, which boils down to (as usual in medicine) an acronym: EMR, for Electronic Medical Records. Even President Bush has seen the benefits, and in his recent State of the Union speech called for national adoption of such records.

Issues abound, of course, such as privacy and confidentiality, the proper amount of patient control over their own records, and the need for uniform formats and standards to keep the data interchangeable. But with those standards coming into place, it’s practically inevitable, with the aging population and the need to cut costs, that a more efficient way to store records be put in place.

Ritchie, who came aboard at the request of Dr. Bob Hakala, said he began doing research, and “what I realized was, there was a large potential benefit to EMR.” And he found that retired doctors were much more interested in taking up the challenge of a new way of storing patient records, because unlike those in a typical practice, “they’ve got the time” to learn the new methods, and to keep tabs on medical progress.

The biggest problem in the weeks leading up to the system’s debut wasn’t in the technology, but the frailty of the human body – namely, Ritchie’s. A month ago, the 62-year-old engineer was on a ladder, working on installing one of the wireless access points in the ceiling, when he took a bad fall, badly injuring his elbow. Surgeons gave him a new, titanium joint, and though there’s still a lot of pain, he’s been back at work.

Retired doc marvels at computer’s assist

Ritchie’s partner in the IT area is retired anesthesiologist Tom McGranahan of Sunriver, who’s 72 and has become quite adept at showing off how the Tablet PCs and the software from E-MDs (www.e-mds.com) will help all of the health professionals do their jobs better.

"What I realized was, there was a large potential benefit to EMR (electronic medical records)." Doug Ritchie IT director, Volunteers in Medicine Clinic

“When I was in med school, I was going to be a ‘GP’ – a general practitioner,” McGranahan said. “That was the only doctor I ever knew.” But pretty soon, he learned just how much he’d have to learn about every system in the body, and figured out: “I’ve got to find a specialty.”

“Had this software been available – all the questions and answers, the curbside consultant” that takes your findings and gives you likely diagnoses – McGranahan said he may well have stuck with the original idea of being a GP.

Ritchie said medical schools are starting to turn people out with training in what’s called “medical informatics.”

The IT leader has been setting up what you’d expect for such a system, with a hefty server and backups, including tapes that are stored offsite. The clinic is equipped for both wired and wireless data transmission – and it all cost under $100,000, which wasn’t in the clinic’s original budget.

At the heart of the system for VIM is the EMR software. After evaluating all the software available last year, Ritchie and VIM officials chose the E-MDs software, which he said was a strong mix of functionality, flexibility and depth (as well as pricing). The clinic bought modules that can be used to chart and schedule patients, scan in paper records, and for task and patient-flow management.

“The choice has turned out to be a good one as the software is performing as promised and the learning curve for our users is not too steep,” Ritchie said after the first week of dress-rehearsal clinics.

VIM's approach was to add the use of wireless, networked Tablet PCs, providing for the kind of mobility doctors need, and the ability to capture patient information in real-time, without having to wait for it to be transferred to another device. The caregivers are at various comfort levels with the system early on, as might be expected, Ritchie said, but some already are using it directly in patient encounters.

Ritchie said the Net has been invaluable in making the clinic project happen, and pointed to Websites as www.techsoup.org, which helps nonprofits get free or discounted software, donated by the manufacturer, including biggies like Microsoft. Ritchie said that was separate from the decisions to use e-MDs software, and the separate choice of Tablet PCs as the hardware platform.

And he insisted this is not bleeding-edge, but stable technology, with the Tablet PCs using Windows XP Tablet Edition. Ritchie and McGranahan went to the E-MDs headquarters in Texas for training. They tried the slate version (without a keyboard) and the convertible kind of tablets, which have a keyboard you can fold out of the way, and the latter proved a more logical fit with the clinic – no need to hook up to a “docking station’ to type in one’s notes..

And how rugged are the 3.3-pound devices, of which the clinic currently has five? “I wouldn’t drop one,” Ritchie said, considering they cost $1,500 to $2,000 each.

The software has several modules, including scheduling and front-office management, but the charting capabilities are at its heart. They don’t even try to tackle handwriting recognition – doctors’ handwriting is legendary – and instead, notes drawn on the electronic “pad” are saved as JPEG graphics. It’s still better than pen and paper, of course, McGranahan said, showing how you can “lasso” and move writing around the page, for example.

The Toshiba Tablet PCs in use at the clinic have a 40-gigabyte hard drive, 512 megabytes of RAM and a 1.4 gigahertz CPU, as well as “wi-fi” connection.

Dress rehearsal goes smoothly

Ritchie has pet peeves about the way the Tablet PC market is heading in what he considers “the wrong direction,” which the next generation trying to turn them into PC substitutes – general practitioners, as it were – and cramming them full of all the bells and whistles of a desktop computer. He sees a market opening up for so-called “vertical market” tablets, more focused on a single set of tasks for an industry.

Each day of last week’s dress rehearsal was smoother than the one before, according to Ritchie. “Actually, there were no problems with EMR,” he said. “The only problems that we had were with eligibility (getting it right) and workflow, but they are both now smoothed out.” There’s also been a community care clinic operating in cooperation with Deschutes County for the past 18 months, to prep for the VIM Clinic.

And many of the volunteers aren’t exactly tech novices either. On this day, Harry Anderson, 75, was scanning in paper documents. The 75-year-old retired engineer built radar signals for several top jet fighters, including the F-15, the F-14 and the F-18. “That’s not atypical of the volunteers,” Ritchie said. “This town is full of folks with a lot of background you’re not even aware of.”

There are other benefits to the electronic records, too, Ritchie said. A “virtual private network” (VPN) will allow doctors to check charts from home, in confidential, encrypted fashion. Oh, and each patient will have his or her photo taken, and attached to the chart, to help the volunteer doctors and nurses keep track of who’s who.

The doctors and nurses don’t have a corner on the technology, as you might expect. The staff volunteers also will use computers to check in and out when they arrive and depart, helping in record-keeping, as well as grant-writing and recognition for those who put in a lot of time.

The Tablet PCs are kept in a locked cabinet and must be signed in and out. And because they currently will run only about 2 ½ to 3 hours per battery charge, a full stock of replacement batteries is kept charging at all times, and they are swapped out after two hours. (The tablets also can be plugged into a wall socket, but that limits the mobility, of course.)

Ritchie knew about as much about medicine as McGranahan did about computers when they started out, but both have come to see the benefits of the paperless clinic, both for patients and staff.

"Had this software been available -- all the questions and answers, the curbside consultant - I may well have stuck with beconming a GP (general practitioner)." Tom McGranahan Retired anesthesiologist

And they also see EMR and the high-tech side of health care as quite the lucrative career (or investment) path, for those with an interest in helping doctors make better decisions, and patients get better care – not by making medicine more cold and sterile, but freeing the doctor to be the personable person we’d all like to take our health problems to.

“Tom and I have talked about how, if we were in our 40s, we’d go into business, as a mentor to local clinics and practices,” Ritchie said. “Others need the help of those who've been through this process.”

An average physician submits 300 to 500 claims per week; with transcription costing $3 to $10 per chart, these numbers add up quickly. The transcription expense for medical clinics range from $10,000 to $30,000 per provider per year.

With our EMR, S.O.A.P. note reproductions are just a click away. The accuracy and completeness of the software-generated charts will satisfy the most demanding auditors. All done WITH ONLY MINIMAL TYPING!

Our template based S.O.A.P. notes allow you to select from our library of templates for HPI, ROS, exam, lab, prescription, plan, and patient education handouts; the templates will allow you to click the question, and than click the appropriate answer specific to that question.

For repeat visits for the same symptom (such as flu patients during flu season), just load the default pre-answered template, make any necessary changes, and you're done. If the patient is here for a follow-up visit, you can also load the completed template from the last visit, make the necessary adjustments; your chart is then completed.

For those who absolutely want to avoid typing, our EMR software also works with a number of voice recognition software.

 

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