Are you ready for the paperless practice?

Microsoft Office InfoPath helps makes the move away from paper simple and painless

By Bill Crounse, M.D.

I often say that today’s healthcare worker personifies the information worker. Each day, we must gather, interpret, and document massive amounts of data that can make the difference between life and death. All too often, however, the tools we use aren’t up to the task. Most physicians spend more time on charting and administrative tasks than on face-to-face patient encounters. The situation in our hospitals isn’t any better. Studies show that nurses spend about a third of their time in direct patient care and the rest in time-consuming paperwork.

Some doctors slow to embrace electronic record-keeping

Today, in many of the largest medical group practices in the United States, physicians remain mired in manual paper processes. In fact, my own doctor still uses a paper chart despite the fact that his large, multi-specialty clinic has invested tens of millions of dollars in electronic systems. Why? He says the new systems are just too hard to use. In small group practices of 10 or fewer physicians, paper records are still very much the norm. Overall, fewer than 20 percent of U.S. physicians use electronic medical record systems.

The medical community in the United States lags behind much of the industrialized world in the implementation and use of electronic records. One reason: In most other countries, the healthcare industry and the technology that supports it are government financed. For example, the United Kingdom has embarked on a $15 billion, government-sponsored, multi-year initiative to completely upgrade the nation’s healthcare information technology infrastructure. In the Netherlands, where doctors receive government stipends to invest in information technology, more than 95 percent of clinicians use an electronic medical record when caring for their patients.

InfoPath offers fast access to patient records

But the prognosis for electronic record-keeping in United States healthcare is looking up. The convergence of improved information technologies with the growing political interest in Washington, D.C. has galvanized the industry. In last year’s State of the Union address, President Bush proclaimed that we would have “an electronic medical record for all Americans within the next 10 years.” This was the kick-off of the National Health Information Network. Although politicians and pundits will debate exactly how we will pay for this, the goal is to permanently rid our healthcare system of inefficient paper record-keeping and antiquated workflow processes. This is good news for doctors and patients alike.

Electronic record-keeping devices have been around for years, but the healthcare industry has been slow to embrace them. Now physicians and other clinicians can go paperless with greater ease, thanks to low-cost wireless networks, powerful and portable electronic devices, a wide range of data input options, and increasingly intuitive software.

Today the challenge isn’t so much the technology but getting staff to feel comfortable using it. That’s where innovations such as Microsoft Office InfoPath 2003 come in. InfoPath,the information gathering program in the Microsoft Office System, enables developers to create electronic forms that look much like the paper forms clinicians have been using all along. On a Microsoft Tablet PC or another computer, clinicians can begin using these highly intuitive electronic forms with almost no training. The forms accommodate a multitude of data input options, including keyboard, digital ink, voice, and point-and-click. Information is captured as native XML. This means information being entered into the form can easily be integrated with a database of information on a server. It can also be linked to the kind of legacy clinical information system so common in many hospitals. InfoPath forms are highly adaptive and flexible, so developers can easily tweak the forms until clinicians get exactly what they want. Furthermore, these are smart forms. Data input fields can be structured to accommodate alerts and notifications so the form is always filled out completely and accurately.

Doctors note gains in productivity

InfoPath puts healthcare workers on equal footing with information workers in other industries. It moves data from clunky legacy systems and puts it into an intuitive, user-friendly format. Doctors, nurses, and even patients can literally walk up to a computer displaying InfoPath forms and start entering data, just as they did on paper.

Swedish Hospital Medical Center in Seattle decided to use InfoPath forms in their new emergency room and ambulatory clinic opening just east of the city. An earlier pilot program demonstrated how easy it was for doctors and nurses to enter clinical information into the forms at the point of care. The clinicians at Swedish experienced faster access to patient information and test results and noted a 10-percent gain in productivity.

In Dallas, patients visiting Baylor Healthcare System’s breast-imaging center are now doing new patient registration on a kiosk or Tablet PC using InfoPath forms. After the data is entered, it flows seamlessly into the patient’s medical record. On subsequent visits to the clinic, a patient just swipes his or her credit card to retrieve, review, or update information. The system is similar to the technology now used at most major airports when checking in for a flight. Furthermore, Baylor reports that it is saving up to $15 per patient through more efficient processing of patient information. That’s a chunk of change because the clinic logs 45,000 patients a year. What’s more, the center is now seeing 10 percent more patients with no increase in staffing or space.

InfoPath takes the hassle out of record-keeping

In the United Kingdom, InfoPath is becoming a mainstay for the automation of clinical healthcare forms. The solution is particularly popular in workflow areas where mobility is critical. In Cambridgeshire, England, visiting nurses use Tablet PCs and InfoPath forms to capture clinical information about elderly clients in their homes. Patient data is wirelessly transmitted to and from the National Health Service database, making it immediately available to other members of the care team. Doctors and nurses are also using InfoPath and Tablet PCs to care for patients at the East Elmbridge and Mid-Surrey Primary Care Trusts as well as at the Solihull Primary Care Trust. Now teams no longer have to travel back and forth to the office to update patient records.

Capturing information on paper is no longer an option if we hope to improve the quality and safety of patient care as well as the job satisfaction and quality of life for all who work in healthcare. In the next five to seven years, all clinicians will be capturing information electronically. Thanks to improved and powerful computing devices such as Tablet PCs, and compelling solutions such as InfoPath, the move away from paper need not be difficult, painful, or expensive.

Just ask those who’ve done it.

For more information about Microsoft InfoPath, please visit the Microsoft InfoPath site at http://www.microsoft.com/office/preview/infopath/.

For more information about Tablet PCs, please visit the Microsoft Windows XP Tablet PC Edition 2005 site at http://www.microsoft.com/windowsxp/tabletpc/default.mspx.

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