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Screening Boom

"I've got a blood pressure cuff," said Sellers. "I enter the reading into the computer and it charts it. The graph gives me a good idea of where I am, and if I eat a very salty meal, I will notice that. . . . It lets me see I can't do certain things."

Along with providing online medical records, the program alerts patients when tests are due and points them to information about each test. "It's all about the patient taking responsibility," said Sellers.

This sort of outreach is not limited to large medical plans like Kaiser Permanente. At the Unity Healthcare community health clinic on 14th St. NW, providers remind their clients when they need to be seen. "We like our patients to come back several times a year," said Jose Aponte, the clinic's COO. "Last year 64,000 patients made 292,000 visits."

Finding the Time

In a study published last year, Duke University physicians suggested why compliance with screening standards is so spotty: "Taken together, the time needed to meet preventive, chronic and acute care requirements vastly exceeds the total time physicians have available for patient care," they said.

Technology can help solve that time problem.

"Compliance is close to impossible without some kind of aid, a physician prompt from something like an electronic medical record," said Washington internist Peter Basch, who has invested in a record-keeping system that relies heavily on computerized data and minimally on paper records.

These systems can automatically alert a doctor -- on his hand-held computer device or on a monitor in the exam room -- that the patient he's seeing right now needs a particular test. "Pop-ups appear to remind us that the patient is due for, say, a pneumonia exam, something that typically goes unnoticed," Basch says.

But even physicians without a high-tech office can offer timely checkups, said Thomas Weida, a doctor in Hershey, Pa., who is a spokesman for the American Academy of Family Physicians. "There are lots of different systems for keeping track of necessary screenings. A simple flow sheet is very effective, and it's even more effective the closer it is to the top sheet" in the patient's chart, he said. "I'll often put screenings that might need to be done on the vital-sign sheet."

Still, Weida admitted that when a patient's acute health problems demand substantial time, it's tough to squeeze in a talk about screenings. That's why he suggests what he calls the 50,000-mile checkup at age 50. And while he often initiates this visit, he said he's pleased when a patient takes the lead. "I have many who come in and ask for it," Weida said. "Things change at 50, and it's a good time to go over what's recommended and to talk about things like aspirin therapy, weight, exercise. . . . That's when we'll talk about annual checkups. I may look at lifestyle and if all is fine, I'll say, 'See you back in three years.' " ยท

Kathleen Phalen Tomaselli last wrote for the Health section about bed rest during pregnancy. Comments: health@washpost.com.


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