NT Times, page 2

(Page 2 of 2)



Dr. Sanchez is a deputy coroner and the ambulance service director and is taking a turn as hospital medical director. Each doctor is a solo practitioner with a separate tax ID. “At the end of the day, our paychecks come from our own business, our own patients,” Dr. Fisher said.

They are informal partners, and cover each other’s patients. “We do everything on a handshake,” Dr. Brull said.

It took five years for her to persuade the other doctors to make the switch to electronic records. “Dan was our holdout,” she said.

Dr. Sanchez explained that, at first, “I was not sure I saw the benefits. Now I’m a very big proponent of it. I’ve gotten to the place where I prefer to get an electronic chart over a paper chart.”

Costs, like those to have his dictation transcribed, are down 75 percent. “The volume of paper flowing around has dropped dramatically,” he said. “That alone paid for half the cost of the software in the first year.”

They selected a medium-priced system (from e-MDs, based in Austin, Tex.), obtained private financing and invested $45,000 in software. Dr. Brull said she paid “the lion’s share for the equipment — $40,000 or $50,000 for hardware,” which they also share. Staff members were sent out for training, and last March they closed the offices for two days of instruction. When they reopened, a trainer stayed to help.

The electronic system helps Dr. Brull with just about every part of her practice. She keeps close watch on 250 patients with high blood pressure and 180 who have diabetes. She pays special attention to people who have both problems, summoning them for blood tests every six weeks

The computers make it easier to keep track of them. “We can run a computer report on diabetics who haven’t had appropriate lab work, or people who haven’t had a wellness exam in 10 months or did not have a flu shot,” she said.

When she leaves the office to see patients at a nursing home, she said: “I have access to my notes on each one on the laptop. It takes out the guesswork.” For people who pick up their pills at Walgreens or Wal-Mart, the software forwards an electronic prescription. “We are working to persuade the mom-and-pop pharmacies to get on that system,” she said.

Dr. Brull said she expected to recoup her investment in five years, perhaps sooner. It did not hurt that two other family doctors left the community last April. “All of a sudden, three or four thousand patients had no doctor,” she said. “We took on a large volume. If you work harder, you get more money.”

Still, she said she shared the frustrations of many physicians who say the insurance companies often seem to use delaying tactics to avoid paying for care, even when the bills are delivered to them by computer. “I feel like I spend a lot of time justifying what I do and chasing the dollar,” she said. But despite such concerns, she said, she is too busy to have much time left for complaining. “I am not a very good pessimist,” Dr. Brull said.