A South Carolina company's software helps patients and physicians identify depression, a condition that many patients of primary-care physicians have but few of them self-report.
Primetime Medical Software was founded in 1992, so it's old enough to have shipped its first software on 5 1/4-inch floppy disks. Today, though, the program, called Instant Medical History, comes via the Web and an application service provider delivery model. More than a dozen vendors of electronic medical record systems have IMH interfaced with their systems, but the service also is available to doctors without an EMR—for $50 per doctor, per month.
The company had a tiny vendor's booth at the Dallas Convention Center where the Toward and Electronic Patient Record, or TEPR, healthcare IT trade show concluded Wednesday.
The software helps physicians identify patients with depression, as well as any number of other chief complaints, by automating the subjective portion of the SOAP note (subjective, objective, assessment and plan), which is the standard format physicians use for documenting a patient encounter.
Instead of the physician or a staffer conducting the initial questioning of the patient in person about their symptoms, patients answer questions provided by the software, which can be made available to them for self-assessment in several ways.
Dennis Morrison, the chief executive officer of the Center for Behavioral Health in Bloomington, Ind., who gave a keynote address at TEPR, estimates 21% of patients seen by primary-care physicians are depressed, but only 1.25% of patients self-report that condition.
"Primary care is the de facto provider of behavior health services for 70% of the population," he said.
According to Allen Wenner, an active family practitioner in Lexington, S.C., and vice president for clinical applications design for Primetime Medical Software, the best-case scenario is when a patient calls in for an appointment, is asked if they have Internet access at home, and answers, yes. The office scheduler then asks if the patient will agree to complete the patient-assessment form online. The form is presented either as an extension of the provider's Web site, or at the company's
Web site directly.
There the patient is linked to an extensive online questionnaire, but similar in form to what a customer sees at an ATM with a series of simple questions, one question to a screen, utilizing large, easy-to-use buttons to pick lists and enter their answers. The patient's responses are analyzed by rules-controlled software to guide the assessment through a decision tree of related questions to get at an accurate description of the present illness. The rules are based on more than 100 publicly available sources of evidence-based medicine, Wenner said.
The depression assessment, for example, is based on the Center for Epidemiological Studies' depression scale developed by the National Institute of Mental Health. Wenner said studies have shown that using a computer-assisted tool will produce a more accurate patient history than is routinely obtained in a physician's office with a direct conversation with the patient.
"Most physicians use a medical assistant to take patient information, but this is an assistant that is going to beat any medical assistant you can hire," Wenner said. This "assistant in a box," as Wenner calls it, never gets tired and is never in a hurry.
Also, patients tend to be more open with the computer, particularly with highly sensitive information, such as feelings of depression, Wenner said.
"It's not judging you," Wenner said. In addition, the tool is bilingual. The questions are available in English and Spanish, with translations into English for the physician.
Once the patient is finished, the doctor gets an orderly presentation with the questions and the patient’s answers in boldface type and the alternative answers in lighter face type. Physicians without EMRs can print out the results and make copies for their patients.
Patients who don't have the Internet at home can be asked to come in early to their appointment to fill out the history on a computer or at a kiosk in the office. Computer-phobic patients or those with some difficulty that doesn't allow them to answer the questions themselves can be assisted by designated office staff members.
It takes a patient four to 25 minutes to complete an assessment, depending on the nature of the complaint and whether they've been a patient before. More-complex problems might take longer, but using the system allows the physician to either shorten the visit time, or to reallocate the time spent with each patient on other things, such as patient education.
In a time study at Wenner's own Columbia family practice before and after implementing Instant Medical History, the average patient visit before installation required eight minutes for the subjective evaluation, two minutes for objective evaluation, less than a minute for the assessment and two minutes for the treatment plan.
Using the Instant Medical History system, the subjective time dropped to three minutes, with the same two minutes spent on the physical exam, the same less than a minute for the diagnosis, three minutes spent on the treatment plan, reallocating an additional minute there—and that still freed an addition two minutes to spend on patient education, with time to spare.
"In the end, this really improves quality," Wenner said.
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