Keep Patient Records on an H/PC with pocketCHART

By Timothy W. Urell, MA, DO

Physicians spend as much as 40% of their time producing routine notes and keeping up with the ever increasing demand for paperwork from the government and insurance providers. All things considered, the development of computerized "Electronic Medical Record" (EMR) systems was inevitable.

Such a system would have to be easy to use and highly portable. Laptop computers have been tried, but they are too cumbersome and their batteries simply do not last long enough to be truly useful to a physician.

EMR solution: H/PCs and pocketCHART

Handheld PCs fit easily in a physician's pocket. Their battery life is long enough for most uses, and spare batteries are easy to carry along. The built-in software provides a Contacts database and Calendar for appointments, as well as Pocket Word for memos. Add to these basic features a program called pocketCHART and you have a personal organizer and full-featured electronic medical record keeper in one package.

pocketCHART by PHYSIX (www.gemedicalsystems.com) lets a physician with an H/PC produce comprehensive and legible patient notes with relatively little effort. The Handheld PC has a small keyboard and typing in a lot of text is no fun. Fortunately, pocketCHART uses template-generated notes to speed data entry. They are implemented as user-defined pop-ups, which allow the physician simply to click on the screen to pick items (which are then added to the growing note).

Once entered, virtually all information is available to be "adopted" in other notes at other times. Physicians end up repeating themselves quite a bit in patient notes. The ability to quickly find and reproduce previously enter information is a big time saver. Further, certain information is automatically adopted into summaries displayed at various places in the program.

pocketCHART comes with several types of pre-programmed blank forms you can call up and fill out for individual cases. These include History & Physical, Clinic Follow Up, SOAP, Quick SOAP, Addendum, Discharge Summary, and Referral letter. These represent most of the documents a physician needs to create. In version 1.5 of pocketCHART, the structure of these notes is not user-modifiable. However, future releases will allow the physician to write his or her own note structure.

A Quick look at pocketCHART

pocketCHART's main screen lets you access patient information and create new records (see Screen 1). The large open box in the middle of the screen displays a list of the patients. You can display all, or part of your patient list.

The rest of pocketCHART's features are organized in "tabs." The "Profile" tab (see Screen 2) provides a summary of the patient's medical record. The information is automatically gathered from the notes and prescriptions entered elsewhere. pocketCHART presents the most important data on a single screen.

The government requires physicians to code the diagnoses they make and the procedures. The pocketCHART Codes Tab lets the physician access a reference list of ICD-9 and CPT codes, organized by category to make it easier to find the correct code. Picking codes is the slowest part of using pocketCHART. This is not really a criticism of pocketCHART, but of the code systems themselves.

pocketCHART's "Rx" Tab lets the physician create and print out a prescription. The Prescription Editor helps the physician create the prescription. It is linked to a drug lookup form called the Pharmaceutical Browser, which lets you look up medications along with brief prescribing information. pocketCHART lets you select a template for the way the prescription will look when printed out. After completing the prescription, you tap a "Print" button, which saves the prescription to a .TXT, .PWD, or .RTF file for later downloading and printing.

pocketCHART's Patient Chart Tab (see Screen 3) is the heart of the program. This screen lets you write a new note or view an old one. Every time a physician meets with a patient, the physician creates a "note" that describes the interaction. Because the structure of the note can be complex, pocketCHART splits the screen to make navigation within a note more intuitive. The left pane provides a list of the different sections of the note. Tap on an item in that list and the right pane shows the actual text being created for that part of the note.

Taping on the "Select Template" button pops a template for that section of the note. These templates are almost completely user-defined and can be up to three levels deep. For example, if a patient complained of pain in the left elbow the physician would first tap "pain," then tap "elbow," and finally tap "left." From these three taps, pocketCHART would enter a sentence which read: "The patient also complained of pain in the left elbow".

While many templates come with the program, PHYSIX provides a desktop utility called the Template Editor which allows a user to create his own templates. Writing templates is a meticulous and complex process which takes a great deal of time to do well.

Room to improve

pocketCHART provides physicians with a very useable EMR system. However, pocketCHART stores all of its data in the H/PC's internal memory. This problem is alleviated somewhat in the newer H/PCs with greater internal memory, but pocketCHART really needs to be able to store and access patient data in memory cards. PHYSIX also needs to engineer an easy way to move selected records to and from a desktop PC.

[According to PHYSIX, Inc., a forthcoming product called CE Desktop Link will allow pocketCHART to store patient demographic and billing information on a desktop PC. Uploaded information will be deleted from the H/PC's limited memory, and can be downloaded again when needed. Clinical notes, however, cannot be transferred and still must be printed out and stored in a physical chart.]

I encountered a couple other minor problems. On several occasions sections of notes I had entered disappeared completely or showed up in other parts of the note. Also, it seemed that my H/PC locked up more often when in pocketCHART than when not.

Even with these problems, I consider pocketCHART on the handheld PC to be the most useable EMR system I have yet encountered. I have purchased several of these type of programs and written two myself, and I can tell you that it is not easy to cram all that data into a limited environment. That the team at PHYSIX could accomplish this is a testament to their prowess.

Medical pocketCHART -- A full-featured electronic medical record keeper for Windows CE. Price: $995; Annual support and upgrade $149. Contact: PHYSIX, Inc. Phone: 800-749-2585/713-797-1199; Fax: 713-794-0855; Email: Stephen.Lawrence@med.ge.com Web: www.gemedicalsystems.com

Screen 1: pocketCHART's Main screen lets the physician start a new patient chart or go to the chart of an existing patient. The physician accesses patient information from the tabs on the right side of the large display box. Note that below the patients name in the display box is the date and a description (in code) of his/her most recent medical problems.

Screen 2: pocketCHART's "Profile" tab provides a summary of the patient's medical record. Tap on any item in the three lower summary lists and a complete description appears in the top text box.

Screen 3: The "Chart" tab is the very heart of pocketCHART. From this section this is where point and tap templates allow physicians to write complex notes without typing.

By Timothy W. Urell, MA, DO (TimUrell@compuserve.com) Tim Urell is a board-certified family physician and Manager of Clinical Information Systems at Chino Valley Medical Center near Prescott, Arizona. He is a ardent advocate of using computers to improve medical care, and has worked on several such applications. Also a certified peace officer assigned to SWAT, he is working on a novel combining his experience in medicine and tactical operations.