Electronic Billing
Love it or hate it, electronic transmission of data is the wave of the future. Certain major insurance companies are already encouraging electronic filing of billing information, more and more people are filing their tax returns electronically, and transferal of funds among banks and other institutions is becoming the accepted method. The push is to develop a "paperless office." Although it will be a long time until offices of all types become truly paperless, more people are connecting modems and becoming part of the electronic world village. In this environment, your software and hardware will be even more an essential part of your practice, both from a medical records keeping standpoint, and from a financial management perspective. You have to have a sound system to work with and that is our first topic.
Hardware Savvy
What kind of system do you need? It depends on several things, but a good, general answer is the best state-of-the-art equipment you can afford. It depends whether you are into IBM compatible personal computers, or Macintoshes. At the time of this writing, both platforms are going through periods of great advances in hardware. In the compatibles, the newest kid on the block is the Intel Pentium. This is essentially Intel's "586," the natural successor in the x-86 line (i.e., 286, 386, 486 ...). The Pentium is the current top of the line personal computer processor chip. It is much faster than the previous Intel "clock doubled" chips (the DX2 line) such as the 486 DX2, which runs at 66 megahertz. I don't want to mire this article down in technical jargon about computers, but suffice it to say that for the near future, the Pentium should be the top of the line engine for personal computers.
At present there are two basic Intel Pentium chips: one running at 60 megahertz; one running at 66 megahertz (the latter being the fastest and most expensive). For a doctor who wants to stay with the IBM compatibles, the Pentium based systems is the way to go. Prices at present are around $3,500 for a Pentium system, usually with a monitor and a fair-sized hard drive thrown in. And, with respect to the hard drive, that spinning platter which stores information, the advice today is the same that it has been for years ... buy the best, largest hard drive you can afford.
The Mac Attack
The other popular platform many people use is the Mac or Apple Macintosh. Until lately the Mac was becoming less popular as a business machine. There were several reasons. With the advent of the WINDOWS operating system from Microsoft, the Mac lost its edge of being user friendly. The Mac was always a GUI (Graphic User Interface) or icon driven system in which the user used a "mouse" input device to point and click on an icon or small picture on the screen. Prior to WINDOWS, the IBM compatibles ran on DOS (Disc Operating System), also from Microsoft, but it was a boring keyboard input system which was character based (you had to type in commands to get thing done). Another cause of a move toward the IBM compatibles, was that various IBM clones, came down in price and got a lot cheaper than the Mac, which stayed at an relatively expensive level. Also, with the advent of the Intel 286, 386, and 486 chips, the compatibles got faster and faster, and stayed relatively inexpensive for the amount of computer you got for your money. Another reason for the move toward the compatibles was that more and more software was being written just for that platform. Nowadays, many of the major programs are available in either format.
Power Up
A very recent development in the Macintosh line of computers is the new "Power Mac," which utilizes the Power PC chip (I know, the "PC" chip in a Mac gets confusing). Early testing indicates it to be even faster than the Pentium based systems. This is because the Power PC is what is called a RISC (Reduced Instruction Set Computing) chip. Early Intel chips were based around CISC (Complex Instruction Set Computing) architecture. The basic difference is that the CISC chip has a lot of instructions going on at once and a kind of bottleneck happens. The RISC chip does less things at once, but finishes the task quicker. The Pentium has some RISC characteristics, but is not a pure RISC chip. At this time there are not that many programs written exclusively for the Power PC chip (in computer talk, not many "native" programs). Thus when you run programs designed for other systems, it has to translate the programs, and this slows it down. The Pentium is geared toward WINDOWS and since there are lots of WINDOWS applications out there, for the immediate future, the Pentium will have the upper hand. But as more Power PC systems are sold both in desktop and laptop models, the whole things may change in five years.
Modem Anyone?
No matter which system you buy, make sure you have a modem (modulator/demodulator). This device connects your computer to the telephone jack and through that, to the world. Through modem connection, you can do your electronic billing, electronic faxing using your computer (using program such as WINFAX), send and receive electronic mail (so-called e-mail), do computer searches for clinical literature on various topics, and do much more, sending out and downloading all kinds of communications.
Safe Modeming
One caveat though, as soon as you hook up to a modem, your computer becomes vulnerable to two things: snooping from prying fingers on keyboards anywhere in the world to which phone lines attach; two, you are susceptible to downloading a virus. On the first hand, there are computer hackers who have programs which randomly dial numbers looking for modems and once they find one, they can randomly try passwords hoping to access your data. The other concern involves viral infection. A virus in a computer is much like a virus in the body: it is a self-replicating piece of information which can take over the host and manipulate it for its own purposes and even spread to other hosts through their contact with the infected host. To protect your system from either threat, there are various prophylactic measures you can employ. Number one, don't leave your computer hooked up to the phone jack when you aren't home. Also, purchase a program which allows you to password protect your computer. Many virus protection programs offer this. Secondly, make sure you have a good virus protection program. A good virus protection program will scan the hard drive immediately on start up and can be configured to scan any disk you might insert into your machine (3.5 or 5.25 formats). Believe me, if your computer ever becomes infected and you boot up your computer at work to find all your patient transactions and notes for months have vanished, you'll wish you had protected your machine!
How Big Is Big?
The size of the hard drives which are being installed into computers are much larger than they used to be. An 85 or 120 megabyte hard drive was considered sufficient, but as information increases and as computer software programs are occupying more and more hard drive space, larger drives are the order of the day and the future. Most better machines are now coming with 340 MB, 540 MB, and even 1 GB (one gigabyte or 1,000 megabytes). If you work with graphics and have lots of patient files, then go for at least a 540 megabyte hard drive. Also, whether you opt for an IBM compatible or a Macintosh, one essential software program you should have is one which has various "tool" or subprograms which help to manage the hardware. These programs can maintain the hard drive, locate problems and fix them. In general, most of the software publishers have Macintosh and compatibles.
Getting up to Speed
Once you get a system and get the software loaded, what ways can you use it to speed up your office? We've already touched on the trend toward electronic billing. This facet of the new information superhighway decreases file storage and decreases the lag time between billing and reimbursement. These days, both are great advantages.
Also there are various narrative generator programs. There are medical dictionaries on disk (often on CD ROM), which makes purchase of CD ROM installed on your computer a priority. Using a dictionary on a disk speeds up access time to correct spelling. Depending on how much you want to get into using the computer as a management tool, there is even a program, (mainly used by MDs) called "Illiad" which helps in formulation of a differential diagnosis. In fact, CD ROM is going to be the distribution format of the future and if you don't buy a computer with a CD ROM installed, you will need to upgrade and usually, this costs more money and time than if you bought it already installed.
Space and time keep this article from being the definitive guide for the modern DC who is computerizing the office, but at least it gets you started. So if you are still filing everything by hand, and writing on a typewriter, get computer literate and up to speed with the future. Don't be a slowpoke in the slow lane of the information superhighway or you might get left behind!
John Raymond Baker, DC
Austin, Texas