David Fivenson, M.D.

Choosing Computerized Records from the Beginning

David Fivenson, M.D., Dermatology, PLLC is a specialty clinic dealing with severe cases of skin disease and wound care in the Ann Arbor, Michigan area. It is a one physician "boutique" practice that is a niche within a specialty. I was a referral "sub specialist" dermatologist for Henry Ford Health System Hospital and I decided to create a specialty practice like this because there was a big need in our area for specialty care to severe skin diseases and patients in need of special attention.

I wanted to continue to do both lab and clinical research, and opening my own practice of this kind allowed me to do both. I made a business plan to include complex disease management, and hired seasoned staff including: an office/business manager, a medical assistant, and two RN's with over 20 years experience combined. I knew I wanted to design a paperless system with this new practice because it would provide a good tool to complete dermatology notes faster in order to see fewer patients and spend more time with each. I wanted to really give quality care by seeing ~20 patients a day, plus 10 to 15 photo-therapy patients, instead of the typical 50-100 patients a day many dermatologists see. With electronic charts I am able to spend more time focusing on the patient without being bogged down by paper.

Our Search for the Right System
Starting my practice from scratch allowed me to take my time in finding a system because I didn't have an office system yet and could choose virtually any one. I reviewed demo disks and took Internet tours of about 50 different systems. Out of all those systems I chose Medinotes e by MediNotes Corporation because of its use of graphics and flexibility in being customized for dermatologists. No other system I looked at could be custom fit to my needs as a medical dermatologist. Digital pictures are also an integral part of my records and are put into the system immediately, instead of days later. This was the type of system I was looking for to help me achieve a practice built around patient satisfaction.

I have a separate billing service and use an old-fashioned paper appointment book. I started with three free-standing PCs and two tablet PCs about two years ago. These tablets have minimal handwriting recognition and limited built in digital cameras. We plan to upgrade to a third generation tablet soon in order to remain on the cutting edge of technology. We use the tablet PC in the exam room directly with the patient to access and update the patient's file. We also have a computer at the nurse's station and one in my office for accessibility throughout the office. My staff and I can view any patient chart from our workstations without having to travel to one central location, like a chart room.

Advantages of an Electronic System
With Medinotes e we do not clutter the office with things you normally use with a paper chart system. We have never had to create a chart and for this reason we do not have the cost of chart materials driving up the cost of an office visit. Since I started my practice two years ago, we have created 1800 electronic charts for our patient base. At $8 (national average) per paper chart, that is a savings of ~$9,000 annually, and a total savings of ~$15,000 in the 1.5 years I have been practicing.

We also save on postage because we don't mail any letters. We fax referring physician's letters and estimate we send about 20 faxes a day. We have a flat rate on long distance so it doesn't matter how many we send. We are controlling our cost with that function as well. We will eventually add a way to direct fax from Medinotes e on WinFax from our desktop to eliminate the double step of printing and then faxing paper.

We will soon be on-line with major hospitals for our labs so they will be directly sending lab results to us in the future. We use digital photography and load pictures everyday into Canon Zoom X browser and put them in the chart. This allows the system to show me the progression of a wound and is used for follow up letters to the referring doctor to show progress. This is much more accurate than a description of the wound or sending printed pictures to and from offices.

Portability is another unexpected benefit that we have gained with Medinotes e. I am able to spend more time with family now because anything that needs to be done can be brought home to finish after dinner when it is convenient for me and my family. I just establish a virtual private network. This VPN allows me to access all of my patients' records from home. I can see a patient's photo and entire medical history with a few mouse clicks and not go from memory during an after-hours phone call. I am confident that the network is secure and meets HIPAA regulations.

Running an Efficient Office after the Install
My favorite thing about Medinotes e is that I can do in roughly 10 minutes things like prescription writing, billing, and exam notes, and have a level four or five office visit that makes me viable as a subspecialty practice.

My staff loves the system and has commented on how they just scan insurance cards and consent forms and they are retrievable with the click of a mouse button. All the demographics, social security number and information on the patient are done at the end of the day because it only takes ten minutes to scan all documents into Medinotes e. Everyone goes home on time with no loose ends. Everything is already in the system which makes finding information very easy. We have a cleaner more organized work space which anyone would love.

There is no more guessing on what handwriting says. The pharmacist can see exactly what prescription is written the first time. This guarantees every prescription is filled correctly.

We can print out notes for insurance claims making our HIPAA compliance known to anyone who requests the information. We can pull up information when the patient is on the phone without having to put them on hold to go retrieve the chart. Medinotes e allows you to go in and legally and legibly resolve the note from a previous visit if you need to, whereas on paper this could be confusing with multiple scratches and additions in the text. Now it is all organized in Medinotes e and there is no second guessing of the information that is on the screen. This system was very easy to learn and is easy to teach if any new staff comes into the office. It is not intimidating for new people to come into an electronic environment because it is so simple to use and learn.

My advice for anyone starting out with an electronic system would be to try and learn the system before going live. It makes the work so much easier. Also, try to receive the smallest lease for hardware available so you can upgrade more quickly and stay on top of technological advances. I really like how Medinotes e is built for dermatologists overall. When we were starting out I got a stand alone version of the system first to work for about a month with simulated patients to get a feel for how it worked and what it did. I could then be the advisor for everyone else in my office. Starting my practice was much easier than I expected with Medinotes e and it has given us many benefits that we can not live without.