Emil Baccash, M.D., looked at his beeper, recognized the emergency room phone number and returned the call immediately. Though a solo practitioner in a small practice, he was about to take a quick trip to the cutting edge of information technology on behalf of his patient.
An 88-year-old man who had recently been discharged after undergoing a radical nephrectomy was lying in the ER at nearby Methodist Hospital, struggling with right ventricular heart failure.
The patient was in no condition to give a history. But it wasn't needed. "All I had to do to get his history was dial in to his chart," Baccash says. Within seconds of arriving at the hospital, he pulled up a complete record of the patient's history, condition, current treatment and other important information.
Not long ago, Baccash was a slave to paper records. His Brooklyn, N.Y.-based practice -- which employs a nurse, a billing clerk and a receptionist -- sees mostly geriatric patients. With Medicare as the practice's main source of revenue, keeping everything properly recorded seemed an insurmountable challenge. "The problem is, you can't possibly get everything down," Baccash says.
So late last summer, Baccash leapt into what he considers the future of medical record-keeping. After shopping for a package to help with documentation chores, Baccash signed on as a user of a physician-oriented computer application delivered via the Internet. The application, called Logician Internet, helps physicians create their own documentation and assign billing codes appropriate to the work involved. It also lets physicians store patient records on the Internet in secure files.
The developer of Logician, Hillsboro, Ore.-based MedicaLogic, offers a complete package, including laptop computer, communications gear and printer, for $199 per month. Voice-recognition software and a microphone are included.
The bottom line, says Baccash: "I am able to access records remotely from the ER or anywhere else as long as there is Internet access available."
Baccash is trying to go paperless just as the documentation load is at a new high. "There's so much more paperwork now than there ever was," he says. "Medicine is no longer a one-man decision. It's much more of a system approach. The decisions are made by consensus."
The new software, he says, "forces you to stick to a certain format in the record. You don't forget to put any information in that another doctor or specialist or other members of the team would need to have seen."
For example, all of Baccash's patients' records fall in the CPT code range of 99211 to 99215. The latter represents the most-complex visits for the most-serious conditions and is the higher-reimbursed code. It also requires more information.
"If you don't provide the right amount of information when filing under the highest code, you'll be suspected of overbilling," he says. While HCFA rarely audits, "they could -- I wouldn't be surprised if they do and begin asking doctors for paybacks."
Baccash's documentation system reviews the history notes and makes sure that the length and the complexity of the encounter are in sync. It evaluates a record's 12 basic elements, from chief complaint and medical history to diagnosis and orders, and advises how to tidy things up.
The system, upon reviewing the record of a particular visit, might advise a doctor that his record "does not comply with CPT-99215," listing deficiencies such as "lacks a chief complaint," or "lacks the assessment of three or more chronic conditions."
Baccash breathes a little easier thanks to this electronic assist. "Doctors are not great documenters," Baccash says. "Their habit is just to make some notes and go on to the next patient." With this application, he says, "it's not that hard to get it right."
The user doesn't have to be online to create or analyze the record. Drafts of documentation can be saved, recalled and reworked on an office computer until ready to be stored. Once stored, either locally or remotely, they can't be altered.
Baccash is harnessing the software to create templates for new records. One template is for a "geriatric healthy female" and lists such a patient's common complaints and symptoms -- for example, "urinary frequency" and "cold intolerance."
He's also braving the use of voice-recognition software, acknowledging he's "not that good a typist." The voice-recognition application does fine recognizing medical terminology but doesn't always get ordinary language. "If you say `he can,' the software might change it to `he can't,' " Baccash says. As a result, he is learning to speak at just the right speed so the software captures his language more accurately. And when it misses, "you have to edit."
The portable electronic patient record is just the beginning of a whole new way of administering office practices and managing patients, Baccash says. "It kind of makes medicine fun," he says. "You really have to bond to your laptop -- it becomes like your stethoscope."
Andrew Pasternack is a Richmond, Calif.-based freelance writer specializing in information services.