Doctors Go Digital

In a four-minute gap between seeing patients, physician Catherine Picken stands at a hallway workstation to catch up on some "paperwork."

With a few keystrokes and a point of her stylus on her notebook-sized computer, she transmits a patient report to a referring physician, checks for phone messages, okays two prescription refills, attaches a reminder to a patient's electronic medical chart and fields a question from her office manager about when she wants to go on vacation.

When an icon signals Picken that her next patient is ready to be seen in Exam Room 4, she closes the computer, picks it up and walks to the door. But just before she enters, her medical assistant slips a piece of paper into her hand.

"Better not let Barth see that," Picken says with a laugh, referring to her husband, Barth Doroshuk, chief operating officer and mastermind of the information system that has transformed her medical practice. She folds the paper -- a list of billing codes -- and tucks it discreetly into the pocket of her white coat.

Even in one of Washington's most technologically sophisticated doctor's offices -- a new three-physician ear, nose and throat practice that has opted to use leading edge information technology -- there are still a few bugs to be worked out.

But the advances found in this practice, one of the first in the nation to be "paperless," have also eliminated or reduced a surprising number of the maddening inefficiencies and administrative bottlenecks that plague most doctor's offices -- and presumably will let the doctors spend more time and energy on the practice of medicine.

Since it cost $300,000 to make the Washington ENT Group's K Street office one of the region's first all-digital doctors' offices, it's unlikely that you'll soon see this kind of setup on every corner. Just 3 percent of the 550,000 doctors in private practice in the United States use electronic medical records, according to David Bond, vice president of A4 Health Systems of Cary, N.C. Only 0.1 percent have gone to the paperless lengths of Washington ENT Group, Bond says.

But the project demonstrates how the kind of information technology that has reinvented many U.S. businesses over the past decade is finally moving into the notoriously conservative world of medical practice.

Sure, computers are standard equipment in doctor's offices and hospitals. But most are limited to basic administrative tasks such as scheduling appointments and calculating bills. A few larger groups, including Kaiser Permanente, have taken the leap into using electronic medical records. But there is little, if any, integration of the computer technology that links information directly to patient care, leaving doctors buried in paperwork and bogged down in time-consuming -- and costly -- dictation and transcription. An American Hospital Association study released earlier this month found that paperwork adds at least 30 minutes to every hour of patient care.

Medical records can take days to retrieve in a busy practice -- if they are filed correctly -- and they are still largely fat files of paper bulging with hand-scratched notes and Post-its. Prescriptions are still handwritten, potential drug interactions are screened largely by memory and contacts with other doctors are made by phone.

That's all changed -- or at least open to change -- with the electronic office. Patient waiting times are reduced. Medical records, all digital and stored on the office network of servers, are easier to find, access and use. Lab results are transmitted directly to the office computer system. Phone messages are delivered to the doctor before the patient hangs up. Prescriptions are written electronically, which helps reduce the risk of errors. Health claims are filed with the push of a button. Reports to referring doctors are sent electronically the same day instead of a week or two later by snail mail. The turnaround is so fast that it's even surprised local physicians.

On March 5, just a few hours after seeing a patient, Picken's partner, Thomas Troost, sent his first follow-up report to a referring physician electronically, with the push of a button. Half an hour later, the phone rang. It was the physician. He had a copy of the report in his hand.