Rx for Success

By Edward M. Zabrek, M.D., F.A.C.O.G.

 HP660LX_gray.JPG (5414 bytes)
0"My HP 660LX: the perfect Physician's Assistant!"

6:00 a.m.0 a.m.

The alarm on my "physician's assistant," the Hewlett-Packard HP 660LX Palmtop PC, is chirping politely. I'm on-call tonight and managed to get another hour's sleep after my patient's baby came at 4:30 a.m. I pull out my 660LX and realize that I will not have the luxury of any more sleep. My Calendar schedule appearing on the screen of my 660LX tells me that I need to be in the operating room in less than an hour, and my afternoon is jam packed with patients.

7:00 a.m.

After my shower, I greet my patient in the holding area of the operating room. I pull up his patient history in Pocket Word and quickly review it. Everything is set to go.

7:10 a.m.

Waiting in the physicians' lounge, I review the day's schedule using Pocket On-Schedule (Odyssey Computing, www.odysseyinc. com). I use Pocket On-Schedule (see Screen 1) because it allows me to keep an unlimited number of user-definable contact, calendar, and tasks lists. This feature alone greatly enhances the functionality of my H/PC. My surgical assistant has not yet arrived, and if he's late, it will really throw off my entire schedule. I quickly pull up his car phone number from my Contact Manager, call him and find out that he is only 5 minutes from the hospital. (Whew!) By the time I have reviewed and added to my "tasks " for the day, my assistant rolls through the door and we are ready to go.

11:53 a.m.

The surgery is completed without a hitch, and I have time for lunch before my afternoon appointments. I meet a new physician at lunch today, and scribbled down her contact information on a paper towel (I left my 660LX in my briefcase ­ I should know better).

1:30 p.m.

Back at the office, I have a few minutes to add her name to my "Doctors Contacts" list in Pocket On-Schedule. I also quickly check e/MD2® for CE, a physicians coding program that guides me through the procedures for properly documenting a procedure and billing a patient (see sidebar "e/MD2 Portable Coding Software"). I also use Voice Record to dictate a report on how the morning's surgery went.

1:37 p.m.

Time to backup my 660LX! Whenever I make additions or corrections to the personal or medical information on my "assistant," I back it up using DB-Backup (purchase through Mobilesoft at www.mobilesoft. com; demo available at members.aol. com/pdcjohns/ ).

I used to only perform daily backups, but several months ago I lost a couple of hours of inputted data due to a lockup of my H/PC. (I still can't tell you how I crashed it, but I don't every want to be caught again without a current backup.) With new data input into the On-Schedule fields, and the medical data input into e/MD2 , the small amount of time its takes to backup can save me hours of time and frustration in searching for potentially unrecoverable information.

2:00 p.m.

I interview a new patient from Mexico. This patient has chronic pain in her belly. She is allergic to numerous foreign medications (many of which I have never heard of). I open my Lexidrugs CE program (available from K2 Consultants, Inc.; www.skyscape. com/k2). Lexidrugs CE provides comprehensive information on over 5200 drugs, giving both generic and brand names. The information for each drug includes information on use, dosage, contraindications, interactions, pregnancy implications, nursing instructions, therapeutic category, etc. I quickly search for these drugs and document the U.S. equivalent in her chart. I also input data into the e/MD2 program, creating a "problem list" for the patient, and generating the appropriate information for my office manager to perform her job (Screen 2).

2:50 p.m.

Having completed the interview I once again backup my data. I am now ready to see my regular patients. I use the e/MD2 to input the names of the patients I'll see. e/MD2 presents me with pertinent information about each patient I list, highlighting previous problems. I enter notes about each appointment into e/MD2. The coding data from these entries will be downloaded at the end of the day to my office manager's workstation.

3:20 p.m.

A pregnant patient tells me that her allergy specialist has given her a new prescription, one that I'm unfamiliar with. I look it up in Lexidrugs CE, searching for the pregnancy safety profile. I find that the drug is contraindicated for pregnant women (a big no-no). I phone her allergist and he suggested an alternative medication.

3:40 p.m.

Ah, a rare break in my schedule; a good time to connect up to my Internet Service Provider and check my e-mail. I download my e-mail to my 660LX and take a quick look at it. There's nothing needing immediate attention, which is good because my nurse has just informed me that I now have four patients waiting and I should pick up the pace. (So much for the break in my schedule!)

5:00 p.m.

Time to go home, except that I still have three patients to see. It was a long day, following a long night, but I'm not on call tonight. I finish up, download the new patient data to my office manager's desktop, do one more DB-Backup, and I'm ready to go home and get some ...

6:15 p.m.

BEEP--BEEP--BEEP--BEEP!!!! It's Labor and Delivery informing me that Mrs. Jones is in labor. I pick up some dinner and go back to the hospital's sleep room to grab a bite to eat. The sleep room does not have a TV or radio, so while I wait for Mrs. Jones (nature takes its time with these things) I connect my 660LX to the Internet and, using Pocket Internet Explorer to browse the Web, I catch up on all the important news of the world (90% of which seems to be about a couple named "Bill and Monica").

My HP 660LX keeps me organized and on time, provides me with vital professional information, and lets me keep up with our national soap opera. What more can I ask of a good physician's assistant. *

emd1 gray

Screen 1: The e/MD2 main screen let the physician select a patient record or create a new one, and begin the process of creating a New Evaluation and Management Charge.

EMD10 gray

Screen 2: Lexidrugs CE adds a comprehensive drug database to my H/PC, letting me check dosage, contraindications, interactions and more; any time, any place.

PocketOnSchedule1 gray 

Screen 3: I use Odyssey Computing's Pocket On-Schedule to track contact information (shown here) and appointments on my Handheld PC.

Lexidrug1 gray

Screen 4: The standardized data entry screens in e/MD2 walk the physician through collecting a patient's initial history, examining the patient (shown here), and the medical decision-making process.

 

e/MD2® Portable Coding Software

Based on a Health and Human Services audit of the medical industry in 1996, which alleged over $23 billion per year in over billing by medical professionals, the Health Care Finance Administration (HCFA) released documentation guidelines for medical record keeping in 1997. These were intended to provide structure and consistency to the industry's chaotic documentation/billing system, partially by specifying standardized service codes ("CPT" or "E&M" codes). They also added an estimated 140 to 200 minutes a day per 20 patient visits to document patient visits with the appropriate codes, leading many medical professionals to suspect that the cure was worse than the original disease. Fortunately, I discovered a program for my H/PC, called e/MD2. It has become an invaluable tool that guides me through the labyrinth of red tape that was required of all practicing physicians by these regulations.

The e/MD2 Portable Coding Software was developed for the Windows CE Handheld PC by Rensimer Enterprises, Ltd., of Houston, Texas (www.emd2.com). It guides the practitioner through a series of steps that helps make sure he or she is in compliance with the new federal healthcare regulations. This is important because innocent errors of omission, or a lack of proper knowledge of these new laws could lead to charges of fraudulent billing practices that could result in fines of $10,000.00 per infraction, and even jail time for the unsuspecting doctor.

How e/MD2 works

Step by step, a physician or administrative assistant enters the basic details about a procedure into e/MD2. The program then "intelligently builds" a CPT or E&M service code for the procedure, based on the Documentation Guidelines for that code.

e/MD2 is extremely user-friendly. The physician selects an existing patient from the opening screen, or creates a new patient record (see Screen 3). From the patient screen, the physician can create a note, or prepare to enter a "New Evaluation and Management Charge" using E&M Documentation Guidelines.

The physician then uses a stylus on the H/PC's touch-screen interface to select a service category from a drop-down menu based on the AMA's manual. From there the physician taps the bullet points from the '97 Documentation Guidelines within the three elements that comprise a charge code: History, Exam, and Medical Decision-Making (see Screen 4). Instantly, the program calculates the appropriate code for that patient encounter. When completed, the code and its time and date of entry can be viewed on the H/PC's screen, listing the entire patient service.

The program flows logically through a patient encounter. Clinical notes can be quickly jotted through handwriting recognition software. Both the Clinical Note and the Patient Note functionality can be accessed at any point in the program. Once the patient encounter is complete e/MD2 generates a CPT billing code which can later be uploaded to the computer base station at the office for quick, error-free charges.

Although it's not necessary for a physician to know an individual charge code while he or she is with a patient, the codes help to accurately track medical services given. This would make it easier for the medical profession to spot trends and correct problems in patient care.

If a program such as e/MD2 were universally adopted, physicians, medical, government and insurance organizations would have a means for performing meaningful outcomes analysis, standardization of medical care practices, and ultimately improving the quality of medical care.

More information is available at the e/MD2 Web site at www.emd2.com

 
Zabrek photo Ed (stork@flash.net) is a regular contributor to (and has recently been named Medical Editor of) Handheld PC Magazine. He is a practicing obstetrician-gynecologist in Houston, Texas, and the chief technology correspondent for OBGYN.NET (www.obgyn. net), a Web site for obstetricians, gynecologists, and related industry persons. His ultimate goal is to create the perfect electronic medical record with a major focus on using the Handheld PC to do it.