Your health records: more like a blog, or more like Twitter?

For over a decade I traveled 30 miles south to a rural clinic along I-45 in Fairfield, Texas. There I met one of those physicians that people always think of when they think the word "doctor."

Dr. John Keller is a community icon.

Born south of this small town, he practiced medicine there for over 50 years. Now he's retired, and the community is at a loss.

Though certainly not the cause, his retirement coincided with the roll out of a new electronic medical record, or EMR (sometimes AKA EHR).

This reminded me of a story from Dr. Keller that he related to me over a decade ago. He told me that when he first went into practice records were kept on 3"x 5" note cards.

As someone who has served in various administrative capacities over the years, I've always remembered Dr. Keller's initial non-electronic medical record. And I suspected that his care was super, despite the limitations of space on that card.

Today, EMRs are becoming more and more common. There is still significant resistance from some physicians because of the lack of a unified national standard of connectivity.

That is, one system still can't talk to another.

Plus there is the cost of implementation. Some estimates put this near $60,000 per physician in a practice.

In this day of declining reimbursement it's hard for many medical practices to take the plunge and invest in this new technology.

Plus there is the whole slew of resistance remarks that range from "it'll slow down my productivity," "I'm too old to learn," "there isn't one for my specialty," and on and on.

Personally (albeit I'm a self professed techno-nerd) I haven't seen any of these problems.

We use a nice cloud based system from AthenaHealth which allows us to limit our on site technical requirements and back up, is constantly up to date, and can be accessed anywhere. Patients can even log in to check their test results, pay their bill, or ask me a question.

The electronic prescribing is phenomenal. I haven't written more than a handful of paper prescriptions in a year or so.

But even with all this technology, I'm not sure that we practice medicine any better today than Dr. Keller did fifty years ago. We just document a whole lot more information.

But is it useful?

We're pretty good at not generating a ream of electronic information every time a patient comes in. Some EMR systems accomplish this task (conventional wisdom is that it might help with coding and therefore reimbursement).

But, we chart way more than Dr. Keller ever did. I hope it's still pertinent to our patients complaint.

What's amazing to me is that as we have advanced in our technology we have become more verbose in our ability to describe it.

You could say that we are "health care bloggers" in the patients' medical record.

Whereas Dr. Keller was more like Twitter. He kept his comments to probably less than 140 characters -- and he did just fine.

So Dr. Keller may have been ahead of his time. Maybe we should "follow" him.

Texnology? -- Technology at Texas Dermatology

Technology invades our lives and our medical practice at Texas Dermatology is no exception. Over the last two years we have been on an aggressive campaign to upgrade our practice to include replacing virtually all of our hardware to create a paperless clinical environment.

We use a "cloud based" web software environment to handle all aspects of the clinical encounter from scheduling, checking on insurance eligibility, recording information in an electronic health record, and billing. It surprises many patients to learn that we use data centers all over the world to help us sort and keep track of clinical information. This allows us to rapidly, securely, and accurately file the thousands of pieces of data that are received by our practice every day.

One of the things I'm most proud of is our electronic prescribing rate. We only hand write a handful of prescriptions every month. Instead we send prescriptions to pharmacies directly which allows for patient convenience (its usually ready when they drive to pick it up!) and safety because we can cross check medications against both allergies and potential drug interactions. Refills are also automated and usually have a turn around time of less than an hour after the patient calls the pharmacy during business hours.

We hope that by the end of the year we will have a patient portal active which will allow patients access to some of their account and clinical information, scheduling, and even to submit and receive answers to their health questions.

So what would be the logical next step? A television studio of course.

Yes, its hard to believe but we have just completed construction of a state of the art broadcast studio in our Dallas office. Located in the "green room", we have lights, cameras, and action! We wouldn't have been able to do this project without the great folks at Dallas-based VideoTech and video genius Daryl Newman. He outfitted us with microphones, two broadcast quality cameras, and multiple cool LED lights -- as well as a some instruction!

But the heart of the system is a device from the San Antonio company NewTech. Its called a Tricaster and is sold as a "studio in a box" and that probably describes it well. We are able to mix multiple video inputs, internet feeds from remote broadcasts like Skype, and even local DVD video to make really cool live or recorded productions.

But probably the most exciting thing the device can do is to create "virtual sets". This is where we can use computer generated graphics to change the look and feel of the studio from a news room type environment to an auditorium for a PowerPoint presentation.

Why did we do this? We think it will add to the mission of our practice in communicating information to our patients and to that of our educational program and residency program.

Stay tuned to our website -- www.texasderm.com -- for more details as the project unfolds.


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Location:Kona, HI