You don't need to convince Kenneth Verheeck, M.D., of the need for change. The 50-year-old urologist typically is the first doctor in his four-man practice in Lake Charles, La., to try out the latest innovations in treatment. And he's as open to administrative advances as he is to clinical ones.
So it's no wonder Verheeck has beaten his partners to the adoption of electronic medical records for his patients. His practice, the Urology Center of Southwest Louisiana, started subscribing last June to a Web-based patient-record system from Seattle-based Elixis Corp.
And now that Verheeck has worked through many of the kinks in applying the system, a colleague at the center has promised to try it soon.
The system stores patients' medical records on an Internet-based computer server maintained by Elixis and allows physicians access to them through a secure Web site. This eliminates the problem of misfiled or misplaced patient charts and saves Verheeck's assistants the trouble of finding them, he says.
Plus, once a patient's record is in the system, it takes only a few moments to update after each visit.
Like the system by Hillsboro, Ore.-based MedicaLogic, the Elixis application has built-in prompts that remind Verheeck to enter all information required by HCFA regulations.
In fact, concerns about HCFA's increasing its compliance audits led the Urology Center to invest in the Elixis system, called WebCoder, after it was touted at an American Urological Society meeting in March 1999, Verheeck says.
"We know Medicare is going to be doing a lot of surveying of records to be sure they are complete," he says. "That requires a lot of documentation we might not have been putting in; but with this system, we will."
Typically, it takes Verheeck about five minutes to enter a patient's entire medical history using a personal computer.
The process isn't as painful as it sounds -- the system lets Verheeck make entries a phrase or a sentence at a time with a simple click of his mouse. For example, under the symptoms category, Verheeck can click on "burning with urination" and then list the frequency.
Previously, Verheeck would dictate new findings to be transcribed later and inserted into the patient's file.
"Now, I'm putting everybody on the program, so each time I see someone (since launching the system), I (enter) a complete history and physical. I put in their medications, their surgeries, their allergies," he says. "When they come in again, I'll just add anything new."
In the long run, Verheeck hopes WebCoder will replace paper record storage, even for diagnostic images, which can be scanned into the system. And with Elixis adding new features, the system could be used to electronically generate bills and prescriptions.
For now, Verheeck is the only doctor at his practice creating electronic records, so he prints a copy of each patient record and maintains it in the practice's files for consistency.
As of December, Verheeck had converted about 500 of his 1,500 patients' records to WebCoder. He expects to enter the remainder during the next year as patients come in for annual or semi-annual exams.
The transition, however, has meant Verheeck is devoting more time to patient records than previously, partly because he is starting from scratch. But Verheeck also began with an earlier version of WebCoder, which didn't react as quickly as he would have liked; the latest release is faster, he says. What's more, Verheeck has been using a phone line that can't send data quickly. A planned investment in a high-speed, high-capacity T-1 line will speed the system's response.
In the end, Verheeck expects WebCoder to take no longer than his old method, while saving the center the expense of transcription and protecting it from incomplete records.
Other practices considering such an investment should first make sure they have a physician willing to act as a guinea pig, he advises. "Somebody has to work out the bugs so it's not going to slow things down," he says.
He says it took him about a month to become comfortable with the system, "but it's a constant learning curve. They are always refining it."
As one of the system's first users, Verheeck has been providing feedback to Elixis. For example, he told the company to design the system to pull up records by account number instead of patient name. Because many last names are so common, it was a burden to sort records by name.
The Urology Center pays $1,000 for Verheeck's annual subscription to the system and $500 for additional users. That's a slight discount off the regular price because of his participation in the development and testing of the product. Elixis is charging $195 per month per physician, or $2,340 per year, for new customers.
One unexpected benefit of electronic records is how much they have eased the referral process, Verheeck says. Instead of having patient documents copied and sent by messenger to other physicians, Verheeck can e-mail a complete record. Or he can print a copy for patients to take with them. Patients are surprised and pleased at how quickly the process can be completed, he says.
But the center isn't likely to use some advanced features of the system, at least not right away. Elixis recently launched a service allowing patients to view their medical records information on a secure Web site, YourHealthChart.com, which will draw data directly from WebCoder. The site also could be used to schedule appointments and instruct patients about taking medications.
Verheeck says he is concerned about patient confidentiality and would hesitate to use such a service.
As for e-mail communication with patients, he sees little demand among his elderly patient group. In fact, the center's 7-year-old Web site still is little used.
But someday Verheeck may consider using e-mail and other forms of electronic communication with patients. "I'm just someone who is always looking for the better way."
Lisa Scott is a Chicago-based freelance writer specializing in healthcare business and technology.