First things, first.
George P., sorry for making you wait an hour for your swine flu shot. Jerry Y., sorry you left after waiting an hour to see me, though I understand you are still happy with my care and have rescheduled. Please know things are getting better.
To my front and back office staff, you’ve been great dealing with the all the extra hassles during the first few weeks of the transition.
What am I talking about?
About two weeks ago I started using computers to record my notes after I see patients in my office. Before I start each visit, I spend time carefully entering all medications and pharmacy information, which has a secure connection with the patient’s pharmacy.
Additionally, in between appointments, I have been entering medical histories into the computer, but my patients don’t see that. Soon, the office staff is going to have to scan many pages of old paper medical charts into the computer, one page at a time, and record in the computer what is on each page. This takes a lot of time.
Our experience is being repeated all over the nation, and it’s about time. But as with my office, medical offices all over the United States are struggling with the hassles changing over has caused.
Not only are computer setups expensive, costing at least $15,000 to $25,000 for each doctor from day one, but I am spending time working the computer, which takes away from time I can spend with patients. I’d guess the average doctor loses $20,000 the first year because of fewer patient visits, not to mention ongoing computer-upkeep issues. Office staffs have been severely stressed with the transition.
Until recently, the biggest problem for me has been that most of the computer programs out there were set up using “templates” to record my notes, sort of like filling in the blanks, instead of allowing straight-talking sentences.
But to my surprise, there are now very accurate and easy-to-use computer programs (costs $1,400 per doctor) that let me speak at my normal pace into a headset microphone and up on the screen comes a typed version (not perfect, but pretty good) of an office visit. The use of “templates” should be reduced and limited, if you ask me, now that a better alternative exists. Many doctors type full notes into the computer during an office visit, but I still prefer to do this after we’re done.
The decision to change over to computers has been very difficult for me and the rest of the office. One major question I still have is that since every doctor or group of doctors in the state has his or her favorite computer program, how well will the different programs interact?
And what happens if my computer company goes out of business or raises its price unreasonably or doesn’t keep up, or someone else’s does? We’re all stuck!
Lastly, I am thankful to Blue Cross & Blue Shield of Rhode Island for taking the lead in the state in helping primary care physicians, especially like myself, make the transition. Not only financially, but also in many leadership roles.
I know Blue Cross has caused a lot of grief across the state by raising its rates. But it is our local company, and it invests much of its revenue back here in Rhode Island. It is doing the lion’s share of the work among health insurance companies to shape the future of health care in our state.
Unlike Massachusetts and many other states, for reasons unknown to me, large segments of the physicians in Rhode Island, especially primary care physicians, are not associated with large groups. As a result, it has been especially difficult making the transition to using computers, one doctor or small group at a time. Once again, Blue Cross has accepted its leadership role, and the public should be aware of this. •
Dr. Howard Schulman is a general internist in Warwick and at Kent Hospital; he has been practicing medicine for 15 years.
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