Beyond billing: computers in the MD's office
CMAJ 1997;156:901
© 1997 Canadian Medical Association
"I really believe that we are only beginning to tap computers as a resource for clinical practice," says Dr. Michelle Greiver (mgreiver@compuserve.com), a family physician in North York, Ont.
For her, the Internet functions as both a gigantic filing cabinet and a repository for up-to-date information. "I used to tear interesting articles from medical journals, intending to file them away some day. 'Some day' never materialized, of course, and the articles ended up in the local dump. Now, I have people on the Internet doing the filing for me. I can look up articles when I need them and I can even save a permanent copy by transferring the file to my computer. Of course, not everything is available in this way yet, but more and more journals are going online.
"I often look at clinical practice guidelines, because of their usefulness in general practice. For Canadian CPGs I use CMA Online, where there is a growing collection of full-text CPGs in the CMA CPG Infobase [../../../cpgs]. The US National Library of Medicine has a very good searchable site [http://text.nlm.nih.gov/], with guidelines for screening measures as well.
"For up-to-the minute information it is difficult to beat this form of communication. For example, CMA Online and other sites have health advisories online as soon as they are issued."
Greiver is also an active user of Clinical Q&A, the mailing-list discussion group hosted by the CMA to provide practising physicians with an electronic form of corridor consultation (see CMAJ 1997;156:561 [full text] for a sample discussion).
Last fall Greiver added a second computer at her office, which is used mainly for clinical activities. "I wanted to see if I could make some improvements in the way I practise by having it in the back office. It is not networked with the front-office computer and is not used to enter patient data. Networking is not yet practical in my office.
"I use this machine to write my referral letters. For clinical information, I access an online medical library and MEDLINE. I have started to store some patient-information handouts that can easily be printed when required. I have a clinical directory where I store interesting research results for easy access."
Greiver does not send referral letters via email and doesn't expect to until there is a standard for computerized patient records. Thus far she is corresponding by email with only one type of patient -- computer professionals with whom she barters medical advice for computer advice.
Logging on to her local hospital is so easy that Greiver dials in almost daily to get radiologic and laboratory results, with a dramatic improvement in turn-around time. She uses a differential-diagnosis program if she has trouble interpreting findings.
We invite other physicians from medicine's front lines to tell us (pubs@cma.ca) how they are using computers in daily practice. Are they making a difference?
Highlights from CMA Online
New to CMA Online this month as a bonus for readers of the online edition of CMAJ are reviews of medical software, which are published as soon as they have been edited (../../../journals/cmaj). They will also appear in the Books and other media section of the paper edition.
Cool sites
http://www.cheo.on.ca/asthma/disclaim.htm
Dr. Tom Kovesi (tom.kovesi@sympatico.ca), a pediatric respirologist at the Children's Hospital of Eastern Ontario (CHEO), has created a site, Asthma in Children, in cooperation with CHEO. It has more useful information than any other Canadian or US asthma site, and focuses on a Canadian approach to the treatment of asthma and on medications available for use here. It describes how to use different inhalers and demonstrates what wheezing sounds like. The information cannot be viewed until the disclaimer page has been read; it warns parents not to use the site during an asthma attack or to diagnose or treat asthma in their children.
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