From the archive: Experience with computers in a small office

This is a condensed version of an article that appeared  in the March 1981 issue of the BCMJ.

In the past 11/2 years, this five-physician practice has set about to rid itself of the paperload, improve patient flow and reduce overhead—but most importantly— to increase the pleasures of medical practice… 
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My group of five general practice associates has, since November 1979, phased-in a total computer system custom-designed for office practice. With medical practice being a high overhead, small business, computers are one way to reduce or at least to de-accelerate the rising costs of doing business.

Ideally, the computer will enhance gross income by improved patient flow, reduce overhead by improved office efficiency, and thus increase the all-important net income.

Our aim in introducing computerization to our practice was simple: to rid the office of paper. If this goal could be accomplished, then the pleasures of medical practice—deteriorated because of increasing paperwork—could be regained.
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In choosing to computerize, after weighing the present cost against the future cost savings, we knew that in order to improve our already sound but paper-based management system, the computer should handle: patient registration; appointment scheduling; medical records; billing; and accounting.

The in-house minicomputer hardware purchased consists of a Digital System, using a PDP 11/34 central processing unit, two RK07 disc drives and a TS11 tape drive; 13 terminals and two printers.

DEC, a major manufacturer of modern, modular computer equipment, was chosen since they have an established service network to provide ongoing computer maintenance and repair. Also, the modular design allows new features to be added, as designed, thus staying obsolescence. 

The software, a sophisticated set of instructions, was planned by a design consultant to ensure maximum flexibility, including future modifications.

Patient registration was brought on-line first, with patients being registered as they came into the office, thus updating our patient registry. While it necessitated operating with a dual system of both a paper file and the computer for a time, it was quite workable. 

In the second phase, medical re­cords were fed into the system using a problem-oriented record… 
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In March 1980, appointment scheduling was added, to include hospital, office and private appointments, holidays, days off, and on-call time.

A simple form of wave scheduling is used which smooths patient flow through the office and increases efficiency by spreading the patient load more evenly. Physicians in the group now finish on schedule; patients love it because of decreased waiting-room time; yet it allows the flexibility for walk-ins and emergency visits.

The scheduling shows appointment time, patient’s name, patient record number, telephone number and nature of complaint. Other information can be added.

The next and most important phase is our billing system. The computer generates a tape from the medical record, along with a printout of all billings and these are sent to MSP in Victoria…

The final phase of our system, now being programmed, will provide a complete accounting package, including payroll registry and control. 
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Generally speaking, the impact on our staff has been great. The routine, boring, drudgery part of their jobs has largely been eliminated. They find their work more challenging, more interesting, and more importantly, have extra time for patient contact. 

Computerization is not all roses, of course. It is, after all, a machine, and as such can break down. It is, therefore, essential that at least two people in the clinic be interested and keen in learning how the support system in the computers works. Simple problems can be corrected as they crop up. 
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The computer has had a dramatic impact on the physicians’ use of rec­ords in day-to-day practice. We now use our medical records as an integral part of our daily routine. Systematic record-keeping is easy and not a tedious chore. The record is at your fingertips instantly when on the telephone. Seeing someone else’s patient offers no difficulty because of the format and continuity of records and the fact that the computer printing is always legible.

Consequently, we feel our quality of care is improved. Certainly, our memory for what is happening to the patient is much better. It is possible to review systematically and logically in moments a complicated history spanning many months. This aids diagnosis, ongoing treatment, and is a useful teaching aid. To date, the computer has brought us full circle—back to the initial enjoyment of practising medicine.

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Dr Petreman is a general practitioner in Nanaimo and a past-president of the BC Medical Association. Watch for an update from him in a future issue.