NEWSLETTER APRIL 2002
Issue 3
Hello to all. I would like to introduce Jeff & Katie Caba, Physician Assistants. They have joined me so I can better serve our patients. I would also like to announce our move April 29th into our new office building. It is located off the traffic circle at the Century Drive / Colorado Street intersection. Take the Chandler exit off the circle to Yates Ave. and we are on the corner of Nancy Way/Yates. A map can be obtained at our current facility or web site. The building will house multiple organizations. We are leasing space to a Laboratory who will collect specimens and return to us results from their satellite facility. We have also leased space to In-Med, a company run by Dr. Frost Lee that provides business tools and software to physician offices and provides consulting services to the Healthcare Industry.
We are currently exploring publishing our newsletter on our web site and sending it to our patients with e-mail addresses. If this is successful, we will be able to do more frequent Newsletters and keep all our patients more informed. This Newsletter will provide a brief practice description as well as review what a PA (Physician Assistant) does for patients, discuss what Internal Medicine is as a specialty, and finally explain what is unique about Ponderosa Medical. We encourage you to share your positive experiences regarding your healthcare with others so that we can grow and add more physicians and PAs to the practice. Look for our upcoming letter on sun safety.
Ponderosa Medical sells primary care health care services to adults and adolescents. We provide all the services a typical Internal Medicine practice provides plus services that are unique. We use Physician Assistants to extend the services and expertise of our physicians. We do in office exercise cardiac stress testing, skin surveys and biopsies, excisions, or destruction of skin cancers or pre-malignant lesions. We treat warts and acne. We do Women’s Health treating perimenopausal and postmenopausal issues as well as vaginal infections. We do PAP smears, and breast examinations. We strongly believe in preventative health examinations and coach healthy lifestyle practice. We do school sport’s examinations, employer screening exams, and Oregon Department of Transportation (ODOT) commercial exams. We treat colds, pneumonias, and urinary tract infections. We treat diabetes, congestive heart failure, emphysema, and reflux esophagitis… just to name a few of the things.
A Physician Assistant is a health professional licensed by the state to practice medicine under the supervision of a physician. PAs provide a broad range of medical services that have traditionally been performed by physicians.
As a member of the medical team, PAs diagnose and treat illness, order and interpret laboratory studies, order diagnostic imaging tests and prescribe medications. Close consultation between the PA and physician ensures continuity of care. PAs are taught to know when it is appropriate to have the patient evaluated by the physician. Physician assistants are often referred to as “Physician Extenders” or “Mid-level Practitioners”.
The typical physician assistant has a bachelor’s degree and four years of health care experience before obtaining a Master’s degree in a formal 2-year Physician Assistant training program.
An Internist trains 3 to 5 years after medical school focusing on diagnosis and treatment of internal diseases. That time is focused on hospital and outpatient Internal Medicine subspecialties of Cardiology (heart), Pulmonology (lung), Gastroenterology (liver & bowel), Nephrology (kidneys), Hematology (blood), Oncology (cancer), Rheumatology (arthritis), Immunology (allergies), Neurology (nerves & brain), Infectious Disease (infections), and Endocrinology (hormones, diabetes). Time is also spent with Dermatology and clinical Gynecology. Internal Medicine is not Pediatrics, Obstetrics, Surgery, Orthopedics, Ophthalmology, or Radiology. It differs from Family Practice only in that Family Practitioners spend 3 years in training divided between Internal Medicine and all the specialties Internal Medicine is not. Their training is more divided and less focused. As a consequence, Internists frequently manage sicker and more complex patients as they have multi-system illnesses. Sub-specialists such as Cardiologists only look at and treat heart specific issues and defer other system illness to other sub-specialists. A patient with multiple sub-specialist physician care often gets fragmented care without the whole patient approach which is what general Internal Medicine is all about.
Ponderosa Medical uses modern networked computer tools to improve information flow throughout the organization. This efficiency is translated into increased face-to-face time with patients giving them the old fashioned medical practice of caring and availability. The following is what we tell our patients about our services:
Ponderosa Medical uses CompletePractice software allowing for a paperless medical practice. Your medical records are always just a second away from any workstation in the office. You will never again need to be seen without your medical record available. In a large medical clinic in Oregon it has been documented that 30% of all patient encounters were done without locating the paper chart. That leads to unnecessary lab and diagnostic re-testing and errors in prescribing medications.
At Ponderosa Medical, the professional staff values their time equally with that of yours. This means that we try hard to stay on schedule. We use an electronic scheduling system. It time-stamps the arrival of patients, and monitors how long you have waited in the reception room or exam room. It logs the time the physician spends with you and the time you leave the office. We statistically can document that we see patients within 5 minutes of their appointment time. We do this because we know that your satisfaction is directly related to the time you spent waiting. Dr. Lee is known for greeting his patients in the reception room and escorting them to the examination room when his nurse is busy. This is only possible because the scheduling system notifies everyone when the patient arrives.
At Ponderosa Medical, we strongly believe that your medical record has shared ownership between you and the clinic. The Internet offers the ability to immediately share information and can improve the partnership between the patient and physician. At some point E-mail will be made more secure, but if you are willing to accept the risk that the Internet can be hacked, we will send your office notes and laboratory reports electronically to you. Any corrections or additions you send back to our office are incorporated as an addendum to your record. In a paper world it is too expensive and labor intensive to print out each record, hunt for an address, put the two together on an envelope and affix postage.
Some of our patients are Snowbirds and travel south for 3 to 6 months of the year. We have the ability to write the entire medical chart onto a CD disk that they can take on their travels in case they need medical care during their absence.
At Ponderosa Medical, we are adamant about keeping your Personal Healthcare Information secure. Every night the computer copies all the medical records to a tape drive. One copy is kept off site in Dr. Lee’s house just in case the office is destroyed. The medical records are copied redundantly on the six hard drives of the office network server so that if there is a drive failure there are no dropped beats of information or delays in access. This is referred to in the industry as “Mission Critical” reliability.
No one can hack into our system from the outside due to security firewalls. Within the office, records are protected by user passwords. Some records are further protected by physician password protection only. In addition, an electronic log is created for each patient record identifying who has been in the file and what office visits were viewed.
We have an office wide Privacy Policy. It is posted on our web site (www.ponderosamedical.com) for patients to review and is available as a brochure in the office. This outlines who may have access to your Personal Healthcare Information and why.
In an ideal world, there would never be telephone requests for prescription renewals. Prescriptions are usually written for duration to match an office return appointment. However, we do not live in an ideal world. With all prescriptions written electronically it takes seconds to update the medication record and re-issue previous prescriptions. We continue to strive for the majority of prescriptions to be reviewed and created during an office visit, but due to technology it becomes easier to pull up a patient record, review all current medications and check for allergies and drug-drug adverse interactions. Medication errors are reduced and Polypharmacy kept in check.
Many of our patients travel extensively. Because our records are immediately available and because they are in electronic format, we can help our patients remotely. We had a patient travel to Greece and lose her luggage with all her medications. With a simple phone call we were able to fax her entire list of current medications to her hotel in Greece. We had a patient call from Arizona with an acute respiratory illness and were able to fax antibiotics to a local Arizona pharmacy. We have had an Emergency Room Physician call from New York and by pulling up the patient chart to view on the monitor were able to give pertinent information about past hospitalizations and surgeries and recent lab results saving time and giving comfort to our patient. One of our patients is a cargo ship captain. He sends his blood pressure readings as a spreadsheet attachment via satellite e-mail. We can adjust his medications while he is in the China Sea.
In the perfect world everything is done at the office between 8 AM and 5 PM. But when there are imperfections, there are alternatives. Our digital phone system answers the calls after hours and gives several options. One option is to leave a voice message that is picked up by the staff for the next working day. Some people use this to set up appointments or to be first on the queue for a telephone call back. The other option is to have the call transferred to ring the doctor’s personal cellular phone. Our doctor’s need time in the evenings for family and relaxation, but if there is a true emergency, it is preferable to talk directly to your physician rather than to someone who doesn’t know you from Adam.
All prescriptions at Ponderosa Medical are printed from the computer. The prescription merges with address information, and identifying information of birth date and social security number. It also merges with health insurance information making it easier for the pharmacist to bill the health plan. But most importantly it prints the prescription legibly reducing the potential for serious errors.
All the chart notes are typed into the computer making the notes legible. It takes less time to review a chart when it is organized and legible. This reduces the risk of errors in treatment.
When the doctor orders a test or referral, the order is typed into the medical record. Most health insurance still requires pre-authorizations for most diagnostic image testing or specialist referrals. In our office the authorization number is added to the order document as well as the visit date and time and when the patient was informed. We have had patients call our front desk having forgotten when they were to have the test. Our front desk can open the order document and tell the patient right then the information they need rather than playing phone tag with the back office. I like to think of this as a neural network in which everyone in the office has access to the information immediately.
One roll of Ponderosa Medical is that of assisting you through the healthcare maze. When a specialist’s consultation or management would benefit a chronic or acute medical condition, we at Ponderosa Medical feel we can honestly match you with the best specialist. The same is true should you require hospitalization. More and more we are able to treat patients without having to resort to hospitalization. We do this through better medication and minimally invasive out patient procedures. But sometimes it is necessary for hospitalization. If you are sick enough for hospital, I usually use a hospital specialist who can see you multiple times a day.
Ponderosa Medical employs two physician assistants, Jeff & Katie Caba. They are health professionals licensed by the state to practice medicine under the supervision of a physician. PAs work as a member of the team and are trained in the diagnosis and treatment of illness. They extend the abilities of the physicians, freeing the physician for complex issues yet because of their teamwork, the physician always knows what is going on. Patients will find that Jeff & Katie are very special people who enjoy spending the time it takes for patients to feel comfortable and cared for.
Our front desk receptionist was hired for her people skills. She is gregarious, cheerful, and fun loving. Our goal is to delight our customers and to treat them as honored guests. Our nursing staff was hired for their experience and empathy. Our business office staff was hired for line item accountability and knowledge of the healthcare payor system. They are a great team and work well together.
At present Dr. Lee is the only physician at Ponderosa Medical. He is a master clinician with 21 years in private practice specializing in Internal Medicine. This specialty focuses on diagnosis and medical treatment along with providing Preventative Medicine. Dr. Lee is known nationally for his work with the Federal Office of Rural Health and for working with members of Congress on various healthcare issues. He assisted in the design of the CompletePractice software and is passionate about developing tools to reduce the hassles of medicine and improve the delivery of economically sound healthcare.