Family practice sings praises of Nightingale software

It didn’t take long for Dr. Hanson Lo to become hooked. A few days was all it took, really, he admits. And now, says Lo of his foray into electronic medical records (EMR), there’s no going back.

“If you asked me to go back to the paper route I would hate that,” says


Lo, who moved his Whitby, Ont.-based family practice to a new location a few months ago, says it was at that time he decided to go paperless and make some big changes in the way he and his staff of five worked.

After evaluating a few vendors, Lo decided to go with Nightingale Informatix Corp.’s ASP-based patient access for MDs software, which his clinic runs on both desktop PCs and one Toshiba Portégé 3500 Tablet PC.

“I think it’s fantastic,” he says of the application. “Once you record in the system, it’s stored offsite and any doctor can access it anywhere in the world. It’s such a beautiful convenience. If you have a group practice where you share patient records it’s almost a must; it will make continuity of care so much easier.”

Lo says his practice is currently making use of just one pen tablet.

“Right now we use it sporadically,” he says. “Our aim is to have our nurse use it, because she’ll be the one floating around quite a bit.”

Lo particularly likes the fact that the tablet is lightweight and allows the user to write on it with a stylus just as he or she would with a notepad.

“It’s very convenient and it uses a wireless network so we can take it to different rooms.”

But there are some tradeoffs, he adds. “What I don’t like is the speed of response,” he says. “It is not as good as a desktop but that’s something you have to sacrifice.”

According to Davinder Gurm, who spoke to TIG at the recent Primary Care Trade Show in Mississauga, Ont., the tablet PC provides doctors with the flexibility that comes with mobility in a size and shape most doctors are used to.

“The last thing you want to do is be working on a computer and have the patient think you’re ignoring him … so with this you can have it in your lap just like your notepad,” says Gurm, Greater Toronto Area territory manager for Nightingale Informatix. “With the Toshiba tablets we found the physicians thought it was just a laptop, but it’s much easier to have this option wirelessly in their office, as opposed to having a computer in every room.”

The Portégé 3500 Tablet PC runs on an Intel PIII processor M, and comes in either the traditional clamshell or tablet-based input. Users can input via voice recognition software, use the digital stylus, which converts handwriting to text, or use a keypad.

The modular application allows doctors to do electronically everything they normally do manually.

“What it does is it takes your practising environment and turns it into a paperless environment, says Gurm.

When a doctor checks a patient in, the system brings up the patient’s history, automatically defaulting to the last visit. The doctor can also add diagrams to the record.

The application features 40 templates physicians can use in assessing a patient’s condition, as well as the capability for doctors to design their own templates. As well, doctors can prescribe medication in the EMR, which can be digitally signed and printed out for the patient to take to a pharmacy or automatically faxed to the pharmacist.

“It’s probably not as quick as writing on a note but the beauty is the system is recording all the information for you,” says Gurm. “You don’t have to worry about the doctor’s scrawl so it saves a lot of man-hours for the pharmacists.”

The application also connects to an Ontario database of specialists, allowing doctors to quickly draw up referrals. With the click of a mouse, the doctor can send the specialist any relevant patient history from his or her EMR, as well as diagrams, notes and any other relevant information.

As well, the system provides lab requisition forms for three main Ontario labs. Lab results can be returned electronically, which speeds up the process.

“Most of the paper coming into doctors’ offices right now is lab results, so if you can get rid of that it’s a big chunk of paper coming in,” says Gurm. “It also flags abnormal results in red so the physician doesn’t have to go through a whole stack. At the same time it will send a note to the front desk to call the patient back on an abnormal result.”

Additional capabilities of the system include electronic billing and scrubbing to avoid mistakes that lead to claim rejections by OHIP, and telephone and Internet-based applications that allow patients to self-schedule and check their EMRs (for a fee of $3 a month or $36 a year). Patients can also send messages to the front desk of their doctor’s office for prescription refills, for example, for a fee per message.

“When we did focus groups we found that people loved the idea of having access to their medical records,” says Gurm. “It takes a big weight off the front desk.”

The Nightingale system also performs overnight health card number validation checks, so doctors can know before they see a patient if his or her health card is up to date.

“One of the biggest problems doctors have is people don’t have valid cards,” he says. “Physicians find out later when they submit the claim (the patient) didn’t have a valid card so they’ve got a hole in their receivables.”

Nightingale is one of nine companies approved by the Ontario Ministry of Health for its e-Physician project to develop standards for a province-wide electronic health record.

But while Lo is sold on the idea of using an EMR application, he knows that not all doctors are as equally enthusiastic.

“I think a lot of physicians think it’s a good idea but I think they are put off by the technology part of it,” he says. “I think they feel it may take a long time to get used to it and in the meantime it may slow down the production and they’re just afraid of it.”

Lo’s advice to other physicians contemplating the move is to jump in with both feet and spend the required time getting to know the system’s features and capabilities.

“I think they will see the return on investment of money and time is well worth it,” he says. “It’s the initial uncertainty that is stopping a lot of physicians from doing it.”

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