Losing the Paper Trail.

Electronic records save $3,000 a month, secure information and save time.

Medical practices that have paper medical records face problems with tracking files, inaccurate documentation and security. Several surveys at national healthcare technology conferences last year showed that the percentage of practices using electronic medical records is small, but interest is increasing.

PROBLEM

At Southwest Primary Care Associates (SWPCA), we maintained a hard copy chart system that was difficult to keep track of, wasted the staff's time, and had the potential for misreading handwriting and, therefore, creating inaccuracies. Security was another concern of our practice, which has clinics that treat 7,000 patients a year in Tempe and Chandler, AZ. Written charts could have been viewed by anyone in the office who could get by the person at the front desk.

The paper trail started when a new patient filled out a form. The office put the form in a file that would be clipped together and routed to the back office for input on the patient's vital statistics and medical history. Then it was left for the doctor to review during the visit. Later the doctor would dictate the results of the visit. These notes were moved to another location to be transcribed overnight and put into the waiting folder that would be filed in a permanent location in the office. The transcriptionists often had 200 items a day.

With 50 percent of the practice in managed care, formal referrals meant the file would sit in another part of the office waiting for input by the records staff. When laboratory or X-ray results came in, files often couldn't be immediately found for review. About 80 charts often would be sitting in a milk crate at the end of the day awaiting physician or medical assistant action. If a patient called in with a question in between appointments, someone had to spend time finding his or her chart.

SOLUTION

The initial search for electronic medical records software was unsuccessful: Some software involved too much typing, or navigation was too complicated. We chose MedicWare, developed by MedicWare, Inc. and marketed by Companion Technologies, Columbia, SC., because its functions were similar to how we see patients. "Tabs" in the software windows relate directly to following a patient through their visit, from chief complaint through exam, assessment and plan, including prescriptions and patient education handouts.