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Searching for the Perfect Electronic Medical Record Program

It seems that in every current medical journal, physicians are told they need an electronic medical record (EMR) program to improve the quality of their practice and lives. Physicians are told by medical software vendors that the $30,000.00 to $50,000.00 per physician cost for such a program will be made up in savings in office operational efficiencies. We are encouraged to immediately purchase a program, train our staff, and enter the world of computerized medicine.

I have had an interest in computers for several years. That has allowed me to become very familiar with different types of computers, personal digital assistants, and smartphones. My personal need was to have one computer device running one software program to organize and track the hundreds of different pieces of data that I need to manage on a daily basis. The best program I have found is a software program called Patient Tracker which I have used on my Palm PDA since 2001.

Patient TrackerTM is an easy to use documentation tool designed for physicians and midlevel providers. It offers an alternative to a non-flexible template documentation form which providers often find difficult to use. Patient Tracker has a desktop version, Patient Tracker Professional, that allows backup and synchronization of patient data between any Palm or PocketPC PDA and any Windows based computer. I purchased this initially to backup data that I was entering on my Palm PDA. Having the patients' diagnoses, medications, office notes, and test results in the pocket of my lab coat is a major time saver. It seemed to me then that the more features an EMR had to offer, the more I would have to gain in terms of office efficiency savings.

For more than a year, our group, Southwind Medical Specialists, looked at several such electronic medical record programs. Spending hours meeting and discussing our needs with EMR vendors, the search process was very time consuming and frustrating. I realized during the third vendor presentation that these full-featured EMRs were not going to make my internal medicine practice easier but were going to cost a lot of money and, as one vendor actually confided, make my practice more difficult during the first six months of implementation of the EMR. We decided to not purchase any of these EMRs which we were presented.

Still encouraged by the advantages of using the Patient Tracker EMR, I contacted the programmer and offered to beta test any new upgrades he was programming into Patient Tracker. The programmer and I developed a good working relationship and quickly made improvements in the software. Our group, Southwind Medical Specialists, and Symbion, who manages our practice, have supported the beta testing and implementation of Patient Tracker into the group practice.

Currently, Patient Tracker is used by me, two of our nurse practitioners, and thirteen support people. I carry a Tablet PC that connects wirelessly to the Patient Tracker software that is running on our network server. All sixteen users can access the same electronic chart at the same time and enter data. When a patient is brought back to the exam room, a nurse takes the patient's vital signs, does a review of all medications and what refills are needed and the initial patient history. This information is entered into Patient Tracker so that when I go into the examination room all I need is my Tablet PC. Since the tablet is smaller than a chart and data entry is with a pen stylus, I am able to sit down in a chair facing the patient and make frequent eye contact so that the patients do not feel I am ignoring them to play with my computer. I can pull up previous office notes, hospital discharge summaries, test and laboratory results, and a list of all medications. Patients are impressed when I can quickly display this information to them on a Tablet PC.

After my examination of the patient, I then review all of the patient's medications with him. The Patient Tracker's prescription writer allows me to generate up to fifteen prescriptions on a single letter-sized sheet of paper with my digital signature. I can also print out individual prescriptions with a simple select-and-print command to a printer in the hallway outside of the exam room via a bluetooth interface. This method of generating prescriptions is much quicker than writing out all of the medications by hand, and patients like it better because they can actually read their prescriptions.

The encounter note is entered in either a SOAP or History and Physical format. I prefer the Tablet PCs digital pen to enter office notes because it mimics the paper and pen I have always used. There is also the option of dictating notes using the voice recognition software that is standard with the Windows XP Tablet PC operating system. Drop-down templates and the ability to cut and paste from previous office notes allow me to generate a one-and-a-half page office encounter note that will pass any insurance auditor's scrutiny. I have measured the time it takes for me to do this and it is consistently under three minutes. The efficiency of Patient Tracker's note entry allows me to do most of my notes while I am still in the examination room with the patient. When the patient leaves the examination room, he has his prescriptions and a completed office visit note. On a busy day, I have generated office visit notes for forty patients and have left the office by 5:00 pm.

My staff and I also generate patient notification letters from within Patient Tracker for laboratory and test results with additional instructions for the patient's care. On followup office visits, I can review the instructions with the patients and reference the notification letter on my Tablet PC if needed.

Any telephone calls and conversations between my staff and patients are also documented in Patient Tracker. All of these notes are organized by date and time which gives me a chronological picture of the care the patient receives and makes any discussions with the patient much easier because I know when and to whom the patient talked.

Patient Tracker adapts to the way a physician works through its advanced customization options and modules.

Customization options include:

  • Basic or comprehensive patient assessments
  • History and Physicals
  • Progress Notes
  • Procedure Notes
  • Consultations
  • Discharge Summaries
  • Prescription Writing

Customized modules include:

  • Case Management Documentation
  • Physician Queries
  • Diagnostic Related Groups Management
  • Emergency Department Services
  • Hospitalist Documentation
  • Subspecialty Documentation
  • Mid-level Providers working in an office or hospital setting

Is Patient Tracker the perfect EMR? It is for me because it allows me to look at patient information and not for patient information. I found the software so useful that along with two business partners, Lois Yoder and Dr. Garry Huff, I bought all of the Patient Tracker products. Our coding and documentation solutions company, Advanced Technical Medical Data Solutions, is developing inexpensive solutions for physicians. Because Patient Tracker operates as a stand-alone product and is not attached to a billing or scheduling software, the price of implementing Patient Tracker is less than the yearly transcription costs for most physician practices.

C. B. Daniel, MD

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