Electronic Records Make Life Easier for Pediatricians

Business Wire, Nov 29, 2004

ROHNERT PARK, Calif. -- ChartWare, the electronic medical recordkeeping system that has been awarded five stars by the official journal of the American Academy of Family Physicians, is equally at home in pediatrics, according to Dr. Richard Ripple, who has been a pediatrician for 25 years and a ChartWare user for seven. Dr. Ripple, who has a solo practice in Kahului, Hawaii, says that when he began using the system he knew very little about the technical side of computers.

"The notes we make for children differ significantly from those for adults. Pediatric visits require us to get to the essentials rapidly. Acute visits are symptom oriented and involve taking care of the parents too. Adult acute visits move at a more measured pace since severe symptoms can lead to major diagnoses and review of many systems helps fill in diagnostic possibilities," he explains.

"ChartWare was so easy to use that I quickly adapted it to my own way of working. I can emphasize whatever aspects are important to me, including even using my own phrases. This is extremely useful, since documenting intuitive, quick clinical decision making can be reflected in each note according to structured clinical protocols we learned in training but cannot possibly document in handwriting for every visit. I can make focused points or add as much detail as I want. My notes are so complete and clear that I have never been downcoded."

The system doesn't tell him what to do, he adds, but it does bring to mind, in an orderly way, what he needs to ask patients or their parents. Later, he says, it's an equally clear reminder of what he did or did not do -- a spinal tap? strep test? blood culture? -- so that he isn't worried by uncertainty. "Underlying protocols governing these decisions take years to teach and refine, but you have to apply them in milliseconds. Being able to use these protocols for any note really fleshes out the documentation and relieves tedious note-taking," he adds.

"Over time you could see a thousand children with a headache and fever but one of them will have meningitis. A pediatrician's intuition helps pinpoint those cases and fast but logical note-taking helps process them. You can quickly put down a whole series of impressions that you would find hard to capture in words."

Ripple likes the point and click method available on ChartWare rather than the keyboard used by most other systems. "It's quick, easy to use and portable, a way of getting a high-quality note with relatively little effort." He also appreciates the open-ended way in which the record is built. "You don't have to go to different parts of the program when you move from one symptom to another. It's all in the same place for ease of entry and ease of reading later."

Once the record has been made, he points out, it's easy to give it to auditors without special preparation or to send it out or store it. "It can be put up on a screen or e-mailed or filed so we know exactly where it is. And, afterward, I can always read it without wondering what I meant. What a difference from paper records."