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Doc's Progress Notes

Week of March 12, 2001

Last Updated: 3/18/2001 at 9:19 PM PST

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Monday March 12, 2001

My trip to Seattle and back today went well. Another member of the committee that was meeting today and I left at 6 AM this morning for the meeting in Bellevue which is east of Seattle, across Lake Washington. We managed to make it 130 miles in just over two hours and fifteen minutes despite driving through rush hour traffic into the Seattle area. We were able to use the car pool lanes and were lucky enough to hit them all wide open and to have enough breaks in the traffic jam at the exits we needed to take in order to be able to cut across lanes of traffic to make the exits. We did not have to come to a complete stop on the freeway once going up and only once coming back. That is really incredible luck, especially on Monday morning.

The meeting lasted six hours and was OK. I learned some more today about several things, not all of which had to do with patient privacy or the security of health information. One of the members is the head of IT for the corporation and I was able to learn from him about the upcoming installation of Windows 2000 as the new software for the network and also that Outlook 98 will be upgraded to 2000 when that occurs in the summer. That means that I will have Outlook 2000 on both my home system and my office system at work and so I will be able to synch both using my Compaq iPaq, if it ever gets here.

I was also able to plant the seed about possibly using Pocket PC's as well as the desktop PC's to run our electronic medical record software. They would be very useful once all the hospital functions are turned on like nurse entry of their nursing notes. Imagine not having to write things down then going to a keyboard and entering it in again after your shift was over but using a Pocket PC to enter notes while you are actually doing patient care. Which way do you think a nurse with no time to spare is going to be more likely to enter the data she or he needs to enter? Past the end of her shift when she or he is trying just to get out of the hospital and get home or, if it is simple and convenient to do, immediately as she or he is taking the vital signs or making the observation.

There are plans to also incorporate physician order entry into the hospital functions. This would eliminate transcription errors and provide instant dose checking and drug interaction checking as the clinician entered the orders. Now imagine again, would a busy physician be more likely to embrace this concept if he or she has to wait for a desktop computer to not be in use by one of their colleagues or if they are carrying a handheld or pocket PC around which they can enter the orders on when they think of them then download them to the main system before they leave the patient's room or the floor that the room is on. This would be my vision of what Pocket PC's would allow the medical profession to do in a most convenient and, I believe, a cost efficient manner.

So, tomorrow I am really back in the office. I have one patient still in the hospital to see and our monthly group meeting in the morning. I am sure I have a lot of e-mail at the office to catch up on as well as regular phone messages and chart notes. I purposely did not go near the office today after we arrived back in time. Tomorrow is early enough.

One other thing before I close, our church is having a friends day April 1 when we are supposed to invite someone to attend church with you. I was thinking yesterday how I did not know anyone to invite when the person who rode with me today mentioned that she and her husband attend church thirty miles out of Longview and were thinking they needed to attend closer to their home. I mentioned coming to our church on that Sunday and she said that sounded like a good idea. So, maybe there is one family already to come on that day. I will now look for more.

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Tuesday March 13, 2001

Short post tonight since I just got home and am not on call. Suffice to say that this has been a long day. Details tomorrow, I hope. I was double and triple booked today and had to admit a couple of patients to the hospital that did not even appear on the office schedule. Again, details tomorrow.

Still no iPaq. I was hoping that my writing about what could be done with Pocket PC's yesterday would mean that it would come today. I am beginning to get very impatient again with all the waiting.

Tomorrow is my day off but it will be a very busy day for me. I have a 7 AM meeting at the hospital then I have some hospital medical records to sign and probably one to dictate. I have a little unfinished office paperwork from today to finish then a couple of nonmedical meetings outside the hospital. I also have to get the oil changed in the Jeep and get a couple of estimates on the cost of repairing the damage to it. All in all, a very busy day. See you tomorrow.

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Wednesday March 14, 2001

Now for a little more about yesterday. Again, I was double and triple booked yesterday and was confronted with needing to admit two patients who were not even on that schedule. One has an anemia (low red blood cell count) which we have not been able to find the source of yet. She needs a blood transfusion now so I have to interrupt seeing office patients to do that and arrange the room for her and details about tests to order to try and nail down the cause of her anemia with the help of a hematologist or specialist in blood disorders.

After doing all this now I am more behind so I try to catch up when another patient needs admission. He is a man who has swelling and redness just below his left knee which has come up suddenly and was sent to an orthopedist to try and determine the cause. The orthopedist feels he needs to be admitted for IV antibiotics rather than the oral antibiotic he was placed on twenty-four hours by the orthopedist. Fine but the orthopedist wants me to interrupt my schedule to take care of admitting the patient rather than the orthopedist interrupting his although he knows exactly what he wants done and proceeds to tell me what to order. Since I did not want the patient waiting any longer I acquiesce and take another 30 minutes extra, which I do not have, and take care of admitting this patient.

So, now I am almost 90 minutes behind and profusely apologize to the office patients who have had to wait longer than they had expected to. I finally finish with the remaining office patients a little after 6 PM (I was supposed to be finished with them by 5) and run to the hospital medical staff meeting leaving most of the afternoon charts undictated and some phone calls still to be made. After the medical staff meeting, which thankfully only lasted about 90 minutes, I went up and checked on the patient with the infection and made sure he was settled in and comfortable then went back to the office, dictated the remaining undictated charts and finished the phone calls that needed to be made last night. I finally got home just before 10 PM and wrote last night's update very quickly.

Today began with a very informative meeting of the family practice clinicians in our medical group. We are having a problem with insurance companies paying for more than one hospital visit per day by a family practice physician or someone covering for him. This means that whomever is inpatient patient physician and seeing a patient who has already been seen that day by his primary physician is not being able to bill for that second visit even if it is medically necessary. We will have to come up with a different mechanism for compensating the person functioning as the inpatient physician or develop another model to provide the best care for our hospitalized patients that will allow us to be reimbursed fairly for the care we provide. Being on the Leadership Council, I will be bringing this up for discussion there since the Council is responsible for establishing policy. I have an idea about how to do both things, ensure quality care and make sure the physician rendering it is compensated for the time spent, but will need to run it by a couple of people to be certain it would fly before bringing it to the entire Council. Our Leadership Council retreat in April now has one more issue to discuss and resolve.

I did get caught up on my hospital records this morning after the meeting. I also got the oil changed in the Jeep and got a couple of estimates for fixing the damage to the rear liftgate and bumper done when Stephen backed into the post in the parking lot of the convenience store. I am trying to keep the repair off the auto insurance policy so it won't raise the premium and one of my patients owns a body shop and is trying to see how he can do it for the least cost and still do quality work. The higher body shop has quoted me a cost of $1800 which I think the other shop can beat by quite a bit. I am not in a real big hurry to fix it as it is drivable, just has an ugly dent in the back and air leaks around the liftgate now. We will see.

Tomorrow should be very busy again. I have two of my own patients to see and a couple to see for one of my partners who is off tomorrow as well as my usual full schedule in the office. Thankfully, there are no meetings tomorrow.

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Thursday March 15, 2001

No update.

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Friday March 16, 2001

I was far too busy last night to update this site. Why was I too busy? Because, my iPaq FINALLY came!!!!!! Delanae called me early yesterday afternoon to tell me I had a very valuable package that had just been delivered. She reported that she had only opened the large box but had not opened the boxes inside. It was my iPaq however which immediately made it a great day. Unfortunately, the anticipation of playing er using it later made a long day last even longer. More about my day at the office yesterday later.

After finally getting home, I open the main box to find the iPaq box and immediately try to get into it. Now anyone who has bought an iPaq knows how difficult the box is to get into and how it is actually two boxes attached together. Each has to be opened individually and the various hardware removed along with the documentation and CD-ROM's. Following directions, I turn the battery switch on and close the battery door. The screen comes to life and it is a bright, colorful screen that is going to be well worth the wait. I have compared it to my friends who have HP Jornadas and this screen is so much clearer and brighter and they even admit it. It works perfectly so I proceed to set it up as directed then install the ActiveSynch 3.1 software that came with the iPaq on my home desktop. Everything goes well and I am able to synch my contact information onto the iPaq without problems. I am leaving Outlook 98 on my home desktop until we get Outlook 2000 at the office, then I will intall Outlook 2000, which came with the iPaq, on both systems so I can use the same version on both computers.

This morning I installed ActiveSynch on my computer at the office then synched my calendar from Outlook onto the iPaq and when I got home synched the iPaq with my home computer and now I have my schedule in Outlook on both desktop computers. This is exactly what I wanted the PocketPC for. It looks like I will use the USB cradle at work and the serial one at home as I have been unable to get the driver for my USB card at home to load correctly (more on this problem this weekend). I have a lot of learning ahead of me and am really looking forward to playing learning about the iPaq over the next few days. As I write this I am downloading a free medical software package for it that has about seventy different formulas in it that I can use to calculate various values needed to care for patients. Then, I need to find a drug database for it.

So, what has happened medically the last two days? Let's see, yesterday was my busiest day here up to this point. I ended up seeing fifteen patients in the morning and thirteen more yesterday afternoon after rounding on three patients in the hospital. If these had been all sore throats and colds that would be no problem but mixed in were many people with chronic problems or multiple problems. I was double booked five different times yesterday and three or four today. Today I saw about five less but it felt like ten less. I did manage to get all my phone calls made before I left tonight (as well as last night) since I will be off for four days in a row now and don't want to leave something undone for four days.

Tonight Delanae and I attended another interview dinner. We are interviewing a physician to join our other physical medicine physician as his practice has gotten too large for one physician. This candidate seems to be an excellent physician as well as a nice guy and we will probably offer him a contract. His father lives in Vancouver, WA so he is really interested in the area. We have two more interview dinners next week; they will be for physician assistants to fill the two slots we have at present but are not filled.

I must end this now and go to bed. I was up until almost 1 this morning learning how to use the iPaq then had to be up at 5:30 again. I am running out of energy now. See you tomorrow.

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Saturday March 17, 2001

Today was a day to learn more about the iPaq. Also it was a day for us to sleep late since Delanae and I are both a little under the weather. We have both had sore throats and lack of energy which is due to a viral infection, not just lack of sleep. The good part of this is that we will both get the feeling bad part over and then both feel good again at the same time.

Since I did feel bad I spent the day sitting in front of this computer learning more about the iPaq and a couple of programs for it. Both are from Ilium Software. One is a list maker called ListPro and the other one is called eWallet which stores passwords, credit card information, etc in encrypted, password protected files on your PocketPC and on your desktop. We will be installing ListPro on Delanae's desktop also for her to use. Next, I am going to go looking for some games for the iPaq. :)

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Sunday March 18, 2001

Delanae and I are still not feeling up to par. We missed church this morning which is not like us. I tried to get up and go but felt too exhausted. Then, Delanae got up thinking she would be ok to go if she just got moving. She came back to bed about an hour later saying she could not handle it. So, we slept in and went tonight. Delanae actually made the practice for the youth choir while I took a nap. This allowed me to make it through the service tonight. I am planning on being much better tomorrow.

Tomorrow is a day off for me as is Tuesday. Originally, we were going to go to Reno, Nevada for the trip sponsored by the radio station Delanae used to work for. After she quit, I did not give back these two days of vacation and it is a good thing I did not. This will give me 48 more hours to recover from this virus. I will not be able to sleep in late tomorrow however as Stephen has to be at school before 7 AM which means one of us has to take him. That job falls to me especially since I also have a Leadership Council meeting in the morning at 7. I could miss it but since I have to be up to take Stephen in anyway I will just go to it. It looks like an important meeting as we will be nailing down the agenda for our two day Council retreat in April and have a long executive session also on the agenda.

I am still searching the Web for software to use on my iPaq. I am concentrating on medical software at the present time and am looking for some packages that are available for the Palm right now but are supposed to be in the process of being ported to the Windows CE operating system. I have joined a listserv group that discusses mobile computing for physicians as well as wireless solutions. It is interesting to read what people are doing out there but most are using Palm OS solutions right now since there are more medical applications written for the Palm at the present. I see the pendulum swinging to Windows CE however and am trying to stay up to the minute on what is out there and available. Of course, one of our own Daynoters, Frank McPherson is one of the leading experts on Pocket PC's and his book "How To Do Everything With Your PocketPC & Handheld PC" has helped me tremendously.

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