One doctor’s digital journey

March 15, 2011

Rockville obstetrician Carolynn Young relied on paper charts for years, but when she opened her own practice last summer, she chose to go paperless.

Now, Young uses a computerized system to schedule appointments, type patient progress notes, review and order tests, fill pescriptions and handle billing. On the top right of her computer screen are several tabs that keep track of incoming traffic, such as lab results and telephone messages. If they are normal, the tabs are gray.

If the tabs turn red, “it’s something urgent or bad,” she said.

On a recent weekday afternoon, Young saw patients for routine exams as well as a woman who had been referred to her for severe pelvic pain. For the most part, she took notes on her laptop while talking to patients in the exam room, then asked them into her office where she continued to record their answers on her desktop computer.

Despite many doctors’ fears that going digital will make medicine less personal, Young has not found that to be the case.

“I don’t feel like I’ve lost the art of medicine,” said Young, 40. “I don’t feel like it’s cold and detached because I’ve implemented electronic health records.”

In fact, several patients said they felt Young has become more attentive. She was comfortable talking and typing notes “very fast,” said Tallulah Palmer, 59.

Going digital will cost Young about $30,000 over five years, but she hopes that doing so will make her more efficient and allow her to better care for her patients.

To help pay for the technology, she’s participating in a program run by Adventist HealthCare, operator of Shady Grove Adventist Hospital, which is located in the same medical park as Young’s office. Adventist provides a $2,400 subsidy to doctors who affiliate with the hospital network and buy one of two designated electronic systems.

Adventist’s goal is for doctors to exchange electronic information with other physicians in the network as well as with other Adventist hospitals, and eventually, all hospitals in Maryland.

“This is the stethoscope of the future,” said Gaurov Dayal, chief medical officer of Adventist HealthCare.

Its program, begun last May, has so far enrolled about 40 physicians. In the District, Children’s National Medical Center has a similar program that started in 2008 and has enrolled more than 150 physicians.

Young likes the benefits the system offers. But after five months of use, she doesn’t feel she is as efficient as she could be. She has to put in extra hours — more than when she had paper charts — tailoring the system for her practice. That means creating checklists that go with different types of exams, for example, or making sure that options to order certain lab tests will always pop up when she specifies a particular diagnosis.

If the diagnosis is pelvic pain, for example, she set up the system to bring up all labs she would typically want to consider for that diagnosis, she said.

“Anything it does is going to be something you have to put the time and effort into for the initial setup,” she said.

She may have to spend another $1,000 to $2,000 for more training and for help setting up a secure patient portal where she can leave a copy of normal lab results and messages for patients.

She’s not sure whether she qualifies for any of the federal government’s incentive payments to doctors who effectively use electronic health records and have either Medicare or Medicaid patients.

“I don’t plan on getting much if any money back from the government,” she said. “I implemented [electronic health records] because I think it is the right thing to do. It is a move in the direction of the future.”

sunl@washpost.com

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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