Physician Data Entry is the Solution - electronic point-of-care systems - Industry Trend or Event

Health Management Technology, May, 1999 by Dale R. Symes

How a group of physicians were persuaded to use data entry point of care electronic medical records to cut costs and increase efficiency.

The dream of computerized medical records has been discussed at length by physicians and in the journals. Yet with extensive review of many of these physician data entry electronic medical record programs (PDE-EMRs), we at New Mexico Orthopedic Associates (NMOA) were not sure that the technology was ready for the masses of physicians, many who were not willing to spend countless hours in training. And, taking 15-20 minutes of physician-computer time to create a single medical note, as the standard big name products did, was an obstacle that we could not endure.

One day in 1995, a local physician called us and said that he was involved with physician data entry electronic medical record (PDE-EMR) technology and wondered if we had the time to take a look at his program, called the HUB Computer Medical System. It was oriented around a healthcare industry model called the Foresighted Practice Guideline Model (FPG). The local physician, Dr. Thomas Naegele, is a Family Practice physician working emergency rooms in New Mexico and Arizona hospitals. References remarked on his excellent medical skills in the ER, so we decided to go ahead and meet with him.

We told Dr. Naegele that we have two non-negotiable requirements for a PDE-EMR system: (1) it must be ultimately flexible and adaptable to any of out clinical settings and, (2) data capture by the physician cannot slow the process down. During his demonstration of the HUB Computer Medical System, we learned that Dr. Naegele is also a college-trained computer systems analyst. We were amazed that this program following the FPG model, though very simple, appeared to handle all situations within clinical healthcare and the business of healthcare. It looked like his system would meet our requirements.

Building The Data-Base For Orthopedic Medicine

We decided to purchase the software for the NMOA practice along with training time with Dr. Naegele. While working with Dr. Naegele, it soon became apparent that he thoroughly understands computer hardware and software in all aspects. He is well versed in computer operations management and development. Unlike all my personal experiences with "system types," Dr. Naegele is very creative with how he adapts to the circumstances he encounters.

Specifically, one of our physicians had insisted that his "template output" be replicated by the HUB system. I was ready to resist such a requirement, but Dr. Naegele insisted the confidence of the physician was paramount to our ultimate success. He replicated the output and then the physician realized the short sightedness of his insistence. He allowed reasonable modifications that made the HUB function more smoothly. His FPG Model really works.

The FPG model is very easy to underestimate because it looks and seems so simple, but after extended use, it becomes very clear that this simple FPG model can easily run and manage the largest of healthcare facilities. It can all occur in the background so the users and information system's personnel will need very little interaction for full functionality.

After a year of working on the database for a few hours per week, we had a physician, Dr. Anthony Pachelli, who was ready for implementation. We opted for the radio network so that Dr. Pachelli could use a hand held pen computer. The first day went okay, but not great. Though there was no problem with the HUB system, the database that we built was not oriented toward the process flow of Dr. Pachelli's clinic.

Over the next day, we restructured the database to better model the actual process flow of the orthopedic physician's job and that was it--it worked! In under a month, Dr. Pachelli was able to see more patients in less time, give more time to the patient, get more complete and accurate documentation to meet all of the new HCFA E&M coding, and cut overhead costs substantially.

Process Flow Management

Process flow management is a well-known tool within the manufacturing industry. However, it is basically an unknown concept within the healthcare industry. Whether one is building a product or one is giving a service, one has to do the job in a specific order in order to get the job done. When building a car, it is plain to see that one has to put the metal sides on the car prior to putting the screws in to hold the metal sides.

However, in service-oriented businesses, there are a number of ways to give service, some of which will be more efficient and productive than others. Within the field of medicine, we have been using the terms slow doctors and fast doctors, but with the concepts of process flow management, one soon realizes that there are organized doctors and disorganized doctors.

The HUB program is the only object oriented PDE-EMR that we have ever seen. The FPG is a process flow management model of the healthcare industry. The usefulness of the HUB system depends solely upon the database that the user builds or uses. There are many databases now available for other specialties that other groups have built.