Doctors Go Digital

To file electronically, senior billing specialist David Trippi dials into an 800 number at Aetna, and transmits the file to the insurance company. In a second, the claims are gone. "If you blink, you won't see it," Trippi says.

This setup also enables Trippi to check on the status of the prior day's claims. When he finds that one has been rejected because of an inaccurate Social Security number, for example, he makes a note and forwards the problem to the front desk at Washington ENT, where it will be corrected.

Trippi will re-file the claim the following day. "The old way, it would take three to five weeks to get word that there was a problem, and then we'd have to refile," he says.

In Sync With the Outside World

Communicating electronically with an insurance company is one thing. But what about sending reports to local doctors whose offices are not quite so state-of-the-art?

"My office is very computer-dependent, but it is not paperless," says Jeffrey Posnick, a Chevy Chase plastic surgeon who often collaborates with Troost. "Even so, it can interface with his very smoothly. I don't have to be at his [technological] level to communicate."

While Posnick still dictates letters and notes, the technological advances at Washington ENT have enabled him to skip a step: The letters he writes can now be faxed directly into the computers at the paperless practice. "We no longer need a hard copy," he says.

Internist Jeffrey Sherman, who practices in the same building as Washington ENT, also has found it easy to communicate with the new practice despite their technological differences. Sherman uses a desktop computer to take patient notes, but prints out reports for his partners, who still rely on paper.

The fast turnaround for reports from Washington ENT is impressive, he says. "What's nice is that you get the doctors' raw notes as well as the letter. It helps you see their interaction with the patient. . . . It's educational."

But other physicians point out that converting a standard-sized practice, which can contain paper files for some 45,000 patients, would be prohibitively expensive and time-consuming. "If I were starting a new practice, I would consider it," said one physician who asked not to be named.

That's a point that Picken, 47, and Troost, 49, can understand. "We were starting new," Picken says. (Their partner, Woll, is 33.) "We didn't have an old office system to transfer over. There was no computer equipment or a roomful of files. We decided to do this so that we would be ahead of the curve. . . . We were making a clean break with our former practices. This seemed like the time to make the big jump."

No power outages have yet plagued Washington ENT. The computer system has not crashed in its first two months of operation. The worst problem so far was when the cleaning crew set off the security alarm in the closet that houses the practice's four servers.

Despite the relatively smooth startup, Picken and Troost say that they have had their doubts about jumping so completely into the digital age. "The first couple of weeks after we opened, I was not as fast at using the computer and I was nervous," Troost says. "But I've already seen the changes."

On a fear scale of 1 to 10, "doing this was about an eight," Picken says. Even though small stacks of paper -- files and reports from other doctors' offices that need to be scanned and shredded -- still dot her desk, she is convinced that it was the right choice. "I feel like I am caught up and in control of my practice again," she says.

The two hours each day that Troost used to spend dictating letters and reports after seeing patients have been cut to 45 minutes. The reports that used to take a couple of weeks to be sent out are mailed electronically the same day they are written and just a few hours after the patient has been examined. The prescription refills that took several days to phone in are also done the same day and patients are surprised -- and often delighted -- when their calls are returned promptly.

"I can catch up throughout the day," Troost says. "I feel less hassled. I have breathing time. I feel like I have gotten my life back."