Easing Workflow in the Palm of Physicians' Hands - ParkStone Medical Information Systems offers physicians free PDA - Technology Information

Health Management Technology, Nov, 1999 by Glenn M. Parker

Portable POC system saves physician time, patient aggravation.

As a practicing internal medicine physician, I found that navigating the guidelines and protocols of a managed care environment often left physicians and patients frustrated. Insurance companies try to distribute their most current formularies, specialist networks, testing protocols, and other such information, while physicians struggle daily to comply with these ever-changing guidelines.

The systems that have been developed to help HMOs control the cost of care by ensuring adherence to each company's specific guidelines have also complicated healthcare delivery. Physicians have had to increase administrative staff, spend less time with patients, and as a result have been concerned about compromising the level of care provided in order to maintain viable practices.

Two Examples

Consider these examples: An elderly woman's health plan may not cover a prescription for bronchitis, and tired of dealing with the pharmacy, she doesn't call the doctor back, assuming it is flu. Three days later she returns with pneumonia. Or a man who does not communicate well is referred to a gastroenterologist for a colonoscopy on suspicion of colon cancer. But he is embarrassed, and doesn't follow through, turning up at the doctor's office six weeks later having lost 25 pounds.

I searched for a technological solution that would ease the daily workflow for physicians while raising the level of patient care. Not finding anything on the market, I approached software designer and system architect Lewis P. Stone, and together we developed a point-of-care tool called PPARIS-Physician Prescription And Referral Information Server.

The palm-sized PC, that slips easily into a pocket like a prescription pad, is used by physicians for medication management, referral generation, formulary management, diagnostic test management, and hospital charge documentation.

Coverage is Assured

The system enables physicians to prescribe medication while working with the patient, with the full knowledge that the medication is covered by the health plan. Quickly and easily the doctor can inform the patient of alternatives, allow the patient to participate in the decision making process, and be confident that the patient's contact with the pharmacy will go smoothly. This markedly reduces pharmacy callbacks and saves time for the physician and staff.

If I were using the system with the first patient case I mentioned, the elderly woman who had bronchitis, the system would have informed me which medications were covered by her insurance plan while I wrote the prescription. At the point of care, while I maintained my interaction with her, I would have been sure that she could get her medication when she went to the pharmacy.

For the second patient, whom I referred to a gastroenterologist for a colonoscopy, I would have made his referral right on the system, and I could have depended on the system to remind me to look for results from the gastroenterologist within 72 hours.

Problems With Callbacks

Dr. Emmet Kenney, with the Cleveland Clinic-Florida, was involved in the pilot rollout of the device earlier this year. "The thing that was obvious right away was that it was a practical solution to a problem that every doctor is suffering with today-pharmacy callbacks," he says. He'd find 10 to 15 pharmacy messages on his desk at the end of the day saying that the prescribed medicine wasn't covered by a health plan.

"You have the time it takes my secretary to take the message. Then I've got to find out what insurance the person is on, if my secretary did not write that on the chart. I have to dig it out, and then the information on that may turn out to be wrong or the patient may have changed plans since the last visit.

"Then I have to look up what medicine is covered on that plan. I might consult a list that is given me from the insurance company, but that's anywhere from three to six months out of date.

"When I finally decide what it is, I call the pharmacy. And if one of the steps breaks down, and the patient goes back to the pharmacy the next day and the medicine still isn't there," Dr. Kenney says.

Callbacks Disappear

The results for him in using the PPARIS system: "I saw those phone calls disappear in 72 hours. I have the savings in terms of my time, my aggravation, my nurses' and my secretary's time-and that pays off right away."

The system keeps a running record of prescriptions written, and prints an updated medication sheet for the patient chart. Also, the practice is notified in advance of pending prescription renewals.

Now all the physicians in Dr. Kenney's practice want the device, which involves 22 residents and 12 internal medicine doctors, at the Ft. Lauderdale, FL-based practice.

At ParkStone, we conceived a systemic way to provide physicians with updates on care protocols, economics, and insurance company parameters. We did this by linking them in a network that could constantly download information into desktop PCs in their care facility and transfer information onto palm-size PCs that are easy to use at the point-of-care. The system, with its Windows-CE-based operating system, is as intuitive to use as a stethoscope.