Record Time

Dr. George A. Saleh is not scared of new technology, new techniques, or the waves of new information that pour daily from the world of medicine. "I have retaught myself five times since I finished school," says the 56-year-old gynecologist in North Kansas City, Missouri. "I now do advanced laparoscopic procedures that didn't even exist 15 years ago."

So Saleh seemed the perfect candidate for a digital, paperless medical office--a system that allows all records and charting to be done on computer. He took out a loan and bought the necessary hardware and software. And last summer, with his staff of three, he switched everything over to the new system. Patient information was entered on a screen instead of on a form attached to a clipboard; Saleh took notes and made orders using a sleek black tablet PC.

Within days, the office was in meltdown. Patients piled up in the waiting room, and Saleh all but lost control of his day-to-day work. Delays grew so bad, Saleh installed a TV to distract patients, and Cerner Corp., the company supplying his software, trundled in refreshments as a goodwill gesture. "I was running an hour-and-a-half or two-hours late," says Saleh. "That's the kiss of death for your practice. It was crazy."

A few months later, Saleh shows off his file rooms, filled floor to ceiling with paper charts. "No paper has been added to these since summer," he says proudly. Not only is his office back on schedule, but his workday is shorter--and he's seeing just as many patients. "When I walk out of the office each day, I'm done," he says. "I don't have to dictate a stack of charts." His bill for dictation services has dropped from $1,200 a month to $60. His staff is thrilled. "It's like a new era," says medical assistant Jamie Clevenger. "It almost feels like a whole new job."

Using digital medical records allows Saleh to file claims electronically, and quickly; he gets paid by insurance companies in 10 to 14 days instead of one to two months. In an emergency, Saleh can access patient charts from home at night; he can view office records from the hospital. The charts themselves cannot be misfiled, misplaced, or left on the wrong counter--they're safe on servers in a Cerner data center designed to survive the most powerful tornado.

Some of the benefits address problems patients would never consider but that doctor's offices have long struggled with. If a birth control pill or cholesterol drug Saleh has prescribed is pulled off the market, for example, "we can push a few buttons and have a list" of who among Saleh's 7,000 patients is taking the medicine, instead of having to go through those charts one at a time by hand.

Saleh doesn't gloss over the tumultuous weeks of transition. He was slowing things down, trying to type into the computer everything a patient told him. He had to reinvent his approach to keeping track of his patients. Working with Cerner, he now has templates with drop-down menus and autofill categories, along with a place for typed comments. "If a woman comes in for an annual exam, I've got a template for the annual exam. I ask her the questions, and boom, boom, boom, I can pick the correct responses. It's done."

Saleh pauses, then brings up a delicate subject. While a bit less personal, the new system "has also made me a better doctor," he says quietly. "There are questions you should ask patients--questions about abuse, about sexual dysfunction. Those are difficult questions. Now I can blame it on the software. It opens up the door to an important conversation." The Cerner software, he says, "has changed the way I work every day, at age 56."

Imagine if stores still put paper price stickers on every item and cashiers still punched in prices on cash registers digit by digit.

Imagine if airlines still used paper tickets--the ones with the red carbon paper on the back of each flimsy flight segment.

Imagine if the banking and financial system still kept most of its records on paper. Not only would there not be anything like debit cards or instant approval of credit-card purchases (remember the booklets of "bad" credit-card numbers that checkout clerks used to consult at the cash register?), there would not be any ATMs. Every time you take money from an ATM, the big banking network consults your account information to make sure you have the money you're requesting.

"It's like a new era," says a doctor's assistant. "It feels like a whole new job."

And yet, in the world of medicine, hurried handwriting remains an essential form of record-keeping. In thousands of hospitals, vital medical records are kept on pieces of paper, snapped into a chart that can be read by only one person at a time, that has to be moved around physically if someone wants to see it, and that is often transported on the lap of the patient, sitting in a wheelchair, on the way to X-ray or the lab or surgery.