Alice G. went to her second appointment with Dale Giolas, M. D., a psychiatrist who uses his computer desktop as a point of care. In her initial office visit with Dr. Giolas, Alice was given a dual diagnosis of a chemical abuse disorder and another psychiatric disorder; she also received medication prescriptions and a printed description of possible side effects and interactions with other medications.
Dr. Giolas subscribes to InfoScriber, one of several Internet companies that update drug interaction information daily. Dr. Giolas explained, “I use it with every patient every day. It helps me know that I am not hurting them with the medications I am prescribing. I also use InfoScriber as a partial electronic medical record because it tracks a patient's diagnosis, medications, and which diagnosis each medication is targeting. I print this out, handwrite my case notes at the bottom of the page, and put the document in the patient's file.
“If I want to fax a copy to anyone else caring for the same patient, such as a psychotherapist or primary care physician, I get a release from the patient along with the other practitioner's fax number, and I then use a program called WriteFax. If the colleague does not have a secured fax machine, I can give a copy of the InfoScriber printout with my notes to the patient to take to the other practitioner. This is great for building up my referral system, because other practitioners greatly appreciate knowing my diagnosis and any medication changes, and reading my comments on the bottom of the page. It also helps us all if our charts get audited, because there is a complete paper trail of the treatment”.
After her first visit, Alice was particularly appreciative of the leaflets Dr. Giolas gave her for the two medications prescribed. She was comforted knowing that her psychiatrist was taking the time to provide her with information tailored to her specific situation. At home, she could read the leaflets at her leisure and come up with questions to ask during her second appointment.
Dr. Giolas said, “There's plenty of reliable information written by other reputable people on the Internet. I don't keep patient information leaflets in my office any more. I print them all off the Internet for each patient”.
Within a minute of greeting Alice and both of them getting settled into their respective chairs, Dr. Giolas realized he didn't have her file on his desk. He unobtrusively signaled “Chart” to his office manager through the instant messaging system on his computer. She soon appeared with Alice's chart. Dr. Giolas explained, “I am in immediate contact with any one of several different offices in my facility, so I can send or receive any type of information that I might need during a session with a patient. We have code systems. We all know, for example, that if I type ‘chart, ’ my office manager knows I am missing