Mark Michels, MD, wants to show what his new toy can do. With a few touches of a stylus on his tablet computer's screen, he pulls up a patient's chart. A couple more touches with the stylus and the screen shows a pinkish diagram of a retina. From a list of diagnoses, he chooses vitreoretinal traction, positions the stylus toward the top of the diagram and - voila! - a vitreoretinal traction appears.

Lesson over, he tries to erase his snazzy diagram. But the vitreoretinal traction won't budge. So he types a note to himself and partner Adrian Laviņa, MD: "Retinal drawing from today is incorrect and should be disregarded."

For 15 years, Michels corrected incorrect drawings by tossing them in the trash and starting anew. That all changed eight months ago, when he and Laviņa adopted an electronic medical record system (EMR). The Retina Care Specialists use the system at their offices in Palm Beach Gardens, Stuart and Wellington.

"Anything new is a little painful," Michels said. "But we are trying to embrace the pain."

Ahead of the Curve
Their efforts put them ahead of more than 90 percent of their colleagues according to Michael Buhler, president and CEO of Maryland-based Health Care Intranet Technologies, which supplied the retina specialists' system.

"Health care is way, way, way behind everyone else," Buhler said.

Michels might have stayed in the dark ages if he hadn't found a new partner. The pair had decided to go electronic mostly because they couldn't always read each other's writing. They also saw EMR's ending the confusion over seeing a patient in one office while her record was in another office, or answering an emergency call at home from a patient whose name dosn't ring a bell.

Michels and Laviņa chose Health Care Intranet Technologies because the company's software is designed for opthalmologists and retina specialists. Most EMR software is geared toward primary-care physicians. Health Care Intranet Technologies' software enables them to create and save detailed drawings of patient retinas and to download digital photos.

Time to Learn
Learning how to use the system has been a greater challenge than Michels imagined. "It's been a painful eight months," he said. "That's been the biggest surprise. It causes you to rethink everything."

Most physicians and their staffs adapt to the system in four to six months, according to Buhler. But he said some could take up to 12 months.

"Training takes at least four days with four hours of training each day," he said. "It's hard to get doctors to take time out of their busy day to be trained."

Some physicians avoid that obstacle by having technicians and clerks input most of the data. The five members of Southern Vitreoretinal Consultants in Tallahassee, for example, dictate their observations during patient exams to a technician who enters the data on a table computer. June Bollinger, the group's administrator, says her staff took just over 2 months to feel at ease with the same type system Retina Care Specialists has. The five-member group shifted to EMR 2 years ago.

"I had people here who'd never used a mouse before," Bollinger said. "Now my staff will never go back to paper."

Yet another challenge for Michels has been the tremendous amount of time he's taken to feed the system with his data. He and Laviņa have written patient information sheets for than a dozen diagnoses. They could have used standard sheets, but wanted to create their own message. Now they're working on a referral letter that can be used for any patient, with just a few additional sentences.

Savings Come Later
For new EMR computers and software, Michels and his partner paid $200,000. They pay another 15 to 18 percent of that per year for tech support from Health Care Intranet Technologies.

I thought we would be able to save on transcription costs," Michels said. "I thought that as our practice grows, we'd be able to treat more patients without hiring more staff."

They may, in time, Bollinger said her Tallahassee practice is just starting to realize cost savings from its two-year-old system.

"We're adding physicians and locations without having to add staff and storage space," she noted.

Frustrations aside, Michels still believes EMR will enable him to fulfill his mission of improving patient care. For the first time in his career, he has access to his patient's records at home. He plans to scan patient's drivers' licenses into the system, so that he and his partners will have faces to help them remember patients. Another big advantage is an end to guesswork with each other's handwriting. Ditto for the pharamcists who fill their patient's prescriptions, which now come out of a printer.

"I'm glad we got the system because I think it's the future of medicine," Michels said. "I like gadgets. It's fun. I think we've got a long way to go, though, to making it a turnkey product."

Once he and his partner work out all the bugs, he imagines EMRs will give them more patient time than ever. "It's about getting more face time with patients," he concluded.