Primary Care Medical Services Goes Paperless

Columbia's Primary Care Medical Services offers a new, eco-friendly spin on the old medical advice to "take two aspirin and call me in the morning."

Patients treated by Assistant Director of Patient Services Debbie Cusack, NP, for example, will probably be advised to "Web message me tomorrow to say how you are." And when that happens, it'll be through a secure Web-messaging system especially designed to safeguard patient confidentiality for the 300 to 400 patients PCMS sees each day.

Since September 1, PCMS has gone paperless. By reducing the potential for about 250 new cardboard patient charts each day as well as reams of paper for records and messages, PCMS is both protecting the country's forests and, longer term, reducing the waste stream. All this, of course, is supported by PCMS' ongoing fundamental concern for the quality of patient care.

Associate Medical Director Marcy Ferdschneider, DO, has been the "driving force" behind PCMS' paperless effort, Cusack says. Ferdschneider, who came to Columbia last spring, was familiar with a program from Point & Click, Inc. software that provided a charting function besides one for scheduling. PCMS has been doing on-line scheduling for a couple of years.

"Ferdschneider came in and said, 'let's roll,'" Cusack says. "She was very instrumental in creating and customizing a system to our needs, then training us in utilizing the system. So on September 1, we were good to go."

The paperless system means that PCMS doctors, nurse practitioners and nurses no longer create paper charts for students who are new to the system. Charts of patients seen prior to Sept. 1, 2006 have been frozen and as these patients make return visits to PCMS they receive an electronic medical record, "with the paper associated with their previous visits scanned into the electronic record, then destroyed," Cusack says.

When a patient visits PCMS on the 3^rd and 4^th floors of John Jay, there's a computer screen open in the examining room for clinician note-taking. Cusack says student interest in the new protocol is high – with lots of "Wow! What are you doing?" reactions.

"It's really a change in the way you work," Cusack says. She describes the staff as enthusiastic about the change and having completely embraced it. "The muttering is totally gone," she says.

When a patient calls PCMS, a receptionist, who'd probably taken a message on paper in the old system, now enters an electronic message for a clinician. The clinician, in turn, responds according to the nature of the patient concern – asking the receptionist to schedule an appointment, for example. This information is then conveyed to the patient. The process takes place without a single piece of paper.

The system is set up for continuity of care, Cusack points out. In the ongoing patient-clinician relationship, such things as patient questions and prescription drug information, for example, are easily addressed. "A couple of clicks on the computer – and the clinician can see doctors' orders and a plan of care," she says.

Cusack says there are still a few pieces of the system that need to "go electronic." An interface with outside labs is being created so their results can be charted electronically. Results of lab work done at Columbia go directly to the patient's electronic record.

Referrals are another area in which an interface is being developed. Cusack describes this work as more complex because of the various insurance companies involved.

PCMS' plan is to keep existing paper charts at Health Services for two years, then move them to a medical records storage facility for 10 years.

"We're trailblazing," Cusack says about PCMS' paperless efforts. She says that Counseling and Psychological Services is "moving in this direction."

Ferdschneider says that New York University, Harvard and most of the University of California's campuses are among numerous schools using the Point & Click, Inc. system that's marketed to colleges and universities.

As for the cases of paper charts left from PCMS' pre-electronic days, they filled the back of Cusack's station wagon – and were donated locally. Cusack took them to a Free Clinic in the Bronx that's run by the Franciscan Friars.

(Photo: Pre-Electronic PCMS Files by Claire Larson)