Mention Santa Cruz, Calif., to most people and they'll think of Monterey Bay, the boardwalk and the town's free-thinking college campus. To Arnold Leff, M.D., what makes the coastal California city of 51,155 residents a place to celebrate is its medical intranet.
It's an extensive web of Internet technology that brings scores of independent physicians into confidential electronic contact with hospitals, labs, radiology centers, pharmacies -- and one another.
The intranet has turned the 90-location Physicians Medical Group of Santa Cruz into a well-wired community, says Leff, a family physician among the 200 doctors in the independent practice association.
Until a few years ago, "we weren't computerized at all, except for billing. And I wasn't, and still am not, computer literate. I may use the computer every hour, but I wouldn't say I'm knowledgeable," he says.
Knowledgeable or not, Leff has gladly traded paperwork for e-mail. "I see a lot of AIDS patients and geriatric patients," groups whose care requires lots of lab and X-ray work. "I don't have to deal with paper for any of them."
A female patient, age 80, recently complained that her rheumatoid arthritis was acting up. Leff arranged, via e-mail, for the woman to have lab work done at a local facility. When the results came back, also via e-mail, Leff forwarded them to a specialist. In the meantime, he was ready to prescribe prednisone, an anti-inflammatory and immunosuppressant drug.
But within minutes, Leff had a reply to the e-mail saying, in effect, that the specialist would make time for the patient first thing in the morning and to hold off on the prescription.
"Five years ago, I would have gotten on the phone, probably have left a message for the doctor, gone to pull the patient's record, faxed the lab results, and waited for a call back," Leff says. "It would have taken so much more time and effort."
The same benefit of timely access extends to reaching back into a patient's history. Not long ago, Leff was called to the emergency room when a patient he was treating for AIDS needed to be admitted.
"From the ER, I was able to access the computerized record of that patient, even though the most recent labs had not been done in that particular hospital," he says. Leff also retrieved and e-mailed digitally recorded dictations.
The benefit: The patient got the needed care quickly. "Without Elysium I would have been unable to access any information about the patient or communicate with the specialist," he says. Elysium is a suite of applications developed by Axolotl, an information systems vendor in nearby Mountain View, Calif.
What all this does, says Leff, is place a burden on the doctor to do more communicating. "But it's worth it," he says. "Instead of having the receptionist handle photocopying, faxing, and calling the other doctor, I can just do the referral, send the authorization and records, all while the patient is sitting there," he says. "The quality of service I'm able to provide to my patients has increased significantly because I can communicate better."
The IPA helped pilot development of the intranet application, and the system's hub of Internet-class computer servers is in the IPA's administrative offices. The larger practices have their own servers, as do buildings with clusters of small or solo practices. Dozens of other locations -- such as labs, radiology offices and a home healthcare agency -- also have servers. Leff gains access via his laptop computer.
The IPA pays for the system; the various physicians aren't billed directly for their access. Axolotl has set a price for new customers of Elysium at $30 per month per user, plus setup fees. The IPA got better terms as an early customer, according to the company, which became a unit of AccentHealth, an electronic media company, in October 1999.
While the intranet hasn't benefited the central administration of the IPA, it has made life a little sweeter for the IPA's physicians. The intranet, Leff says, helps attract and retain physicians, giving the IPA more of an edge in its local managed-care market.
"I think it is a situation where those docs using the intranet and saving money will be able to survive a bit longer," he says.
The improvements in communications and reduction in paperwork have allowed Leff to reduce a staff of four by one person since the Elysium applications came online three years ago. "That's a significant savings, and it's all because I don't have to shuffle so much paper around," he says. Leff estimates staff savings at $12,000 annually.
He happily answers e-mails from his patients and other doctors all the time. The number of phone calls coming into Leff's practice has dropped by as many as 200 calls per day.
Not every doctor in the IPA is as plugged in as Leff. "I divide the doctors into two groups: those who use the system regularly and those who don't, because they don't see the value in it," he says. "Most of the physicians think it's useful and return their e-mail within a few hours. The ones who don't, I know who they are and I call them."
Andrew Pasternack is a Richmond, Calif.-based freelance writer specializing in information services.