Charting
PDA-Assisted Charting: The Simple Choice
When it comes to documenting patients' exams and charts, you have a few options, but none make more sense than the PDA. Here's why.
BY BENNETT McALLISTER, O.D., F.A.A.O., San Bernardino, Calif.

You'll find personal digital assistants (PDAs) such as Palms are everywhere, with more than 20 million in circulation and significant growth forecasted by technology observers. They originated as simple organizers of memos, phone lists and calendars with the intent of supplanting bound organizer books.

Soon, however, their ease of programming and power were tapped and now tens of thousands of programs are available for PDAs. This article outlines how one of these programs has been put to use to turn PDAs into charting assistants.

Bring your PDA into the exam room to record your findings.

Satisfying requirements

Chart documentation has taken on increased importance for optometrists in recent years as the percentage of patients using third-party payers has grown.

Satisfying the third-party demand for charting tasks is often a tedious undertaking for O.D.s. This demand causes tension between the O.D.'s inclination to care for the patient in an individually appropriate manner and the third party's demand for adherence to a rigid set of procedures.

As a practical matter, optom-etrists who want to be good practitioners and still get reimbursed for services must find a way to personalize treatments within the constraints of common documentation parameters. Reconciling these two goals has been the subject of much discussion in the profession. Basically, you can choose from four different paths to successfully achieve the desired balance:

1. good old paper and pen (GOPAP)
2. computerized charting
3. scribes
4. PDA-assisted charting.

GOPAP. Also known as good old paper and pen, this is perhaps the most commonly used charting paradigm. Doctors and their staff record the results of their testing by hand on a form and store the chart in a filing cabinet. Though this system is acceptable to third parties, it's fraught with potential pitfalls, not the least of which are failure to complete each required item and poor or illegible handwriting.

Computerized Charting. This approach has been the darling of the high-tech crowd for years, but has yet to find wide-spread acceptance among doctors. The reasons for this resistance are not hard to find, specifically: high cost, steep learning curve, dramatic change in office culture and what is thought of as high-wire factors.

These risk amplifiers make running the office difficult, if not impossible, and include system glitches; continuous maintenance and support needs; security issues when individuals leave terminals unattended or when someone steals a password; the constant threat of computer virus contamination; and the havoc a disgruntled employee can create. If any of these events occur, the office is effectively shut down until the system recovers.

Scribes. Personal scribes follow you and record results by hand on paper charts and are an option that doctors in other professions seem to utilize more frequently than do optometrists. The scribe is useful in situations where you find both hands occupied and little time between cases to complete charts.

However, personal scribes suffer from some of the same limitations as GOPAP in that their writing may be no more legible than the doctor's hurried scribbles, they may miss required entries and they come with a significant price -- namely their ongoing labor costs.

In addition, the necessary dictation from the doctor can wedge the chairside relationship between doctor and patient.

PDA-assisted charting. This is a little-used approach but it's the primary focus of this article. Although you can implement a PDA in various ways, think of PDA-assisted charting as combining the best of GOPAP with computers by harnessing the common office culture of written records and the power of computers to capture and organize information.

Reviewing the benefits of PDA

Much like a network of desk-bound computers providing a database for electronic patient records, the PDA contains a database in itself. It presents to the user a sequential series of fields that mirror the pattern of questions and tests that you typically follow in an optometric vision evaluation. Answering the query of each field leads rationally to the next field.

Unlike a PC that receives its input through a keyboard, the portable PDA uses a touch screen, which displays each field's question and most common responses. A single tap over the appropriate response selects the desired answer and branches to the next field. Working through the exam sequence in this manner ensures that you don't overlook any critical items. Once you complete the final field, the data transfers through the PDA's IR port to a laser printer. The result is a complete, readable and permanent record of the exam that you can include in the patient's standard chart.

You can also link your PDA to your office or home printer.

Several permutations for PDA-assisted charting are possible. For example, one PDA may follow the patient through the whole exam process from intake to exam, dilation and checkout with a single printing being done at the end, or each staff member may have their own PDA, perform their particular tests and then print the results on the paper chart as they complete them. A doctor could have a personal scribe who records directly to the PDA or who just uses her own PDA to document the exam. The possibilities are only limited by a lack of imagination.

Personally speaking

I've used PDA-assisted charting for more than 1 year and patient response has been positive. In fact, there's a high "grin factor" when a patient realizes that I'm actually using a small computer and that they're the beneficiary of my office's culture of cutting-edge excellence.

The PDA has a disarming quality about it that sets patients at ease and gets them relaxed and chatting. Staffers are enthusiastic about using the PDA and they appreciate the patients' positive feedback. The learning curve is short, and even computer-phobic older staffers jump right into the concept.

Getting prepped

If you're interested in a data collection system that ensures complete records, legible charts, enthusiastic patients and a proud staff, investigate the possibilities of PDA-assisted charting. If a PDA sounds like something you'd like to implement, then you should know a few things before you put the concept into action.

First, know the flow of your office and how you sequence exam steps. Thinking this process through completely allows you to design the program to suit your needs and fit it easily into your office paradigm.

Get a Palm with at least a 33-MHz processor and concentrate on Palms with the faster processor and high resolution mono-chrome screens because color screens drain batteries faster and aren't necessary.

Second, because no turnkey programs are currently available, you need to choose from one of the databases that are established for the Palm platform and write your own. Getting into the writing helps organize your thinking and can streamline your office flow. This mode of chart documentation demands minimal monetary investment or wholesale changes in office culture.