As an "IT guy" who's also closely associated with several different vets through rescue and our local school, there's lots that veterinary offices AREN'T doing to get and keep their computers up and working in a way that is going to be best for them.

A local vet office just paid $10,000 for a computer system without buying any additional computer hardware. They still have the same old single hard drive in their 'server', they still write their backups to (often faulty) DVD-RWs, and they still have the same eight year old PCs at the front counter with no battery backups in a rural area with bad power. In the pharmacy and lab, there are often techs waiting in line to input things into the computer.

It makes me want to bash my head against the desk.

I realize that the margins are slim in veterinary medicine, but having the "cashier's" PC crash three times a day doesn't help. Having the server (and the entire records application) down once a week doesn't help, either. Potentially losing data could be disasterous.

If you're going to do it, don't skimp on hardware. Talk to someone, even if it's not your normal computer support employee or person, who wants to help you make your business better. I bet that every single veterinarian has a customer or spouse of a customer that'd be happy to volunteer their advice. I'd do it for free, although I sure wouldn't mind a couple free doses of Advantix or Interceptor. ;)

Karl Katzke April 28th, 2009 01:13:21 PM

I agree, don't skimp. We have run on computers since I started here 5 years ago and while they are so handy and great. When they're not working they cause more havoc than they're worth. We aren't paperless either.

Kathy April 28th, 2009 01:23:42 PM

If your going to do it right you have to have either a full time IT guy (like above) on staff or at minimum on contract and on call.

Evet April 28th, 2009 01:24:39 PM

Another huge, HUGE way that computerized records will make for better & safer delivery of medical services is LEGIBILITY.  The old joke about "doctor's handwriting" is no joke at all when the pharmacist can't read what the doctor wrote on the prescription.  The pharmacist then has to call the doctor's office for clarification, wasting time.  And if the pharmacist doesn't get clarification for some reason - she THOUGHT she knew what the script said, or the contact in the doctor's office just made a best guess - then the results can literally be life threatening.  And that sort of thing happens every single day!

Barb April 28th, 2009 01:28:25 PM

My line of work is involved in health informatics.

The typical objection of independent and small-business practitioners to implementation of an electronic medical records system is financial.

Yes, some free software is now being made available. But you still have to learn it, your staff has to learn it, and then -- like all software -- it has to be maintained. Time for upgrades, installation, and bug fixes.

I don't think these are adequate excuses for not EVENTUALLY getting on the bandwagon, but I can sympathize, especially for doctors in small offices with limited staff.

I would imagine the same objections are raised by vets. It's one thing for a VCA or Banfield to purchase and implement a system. It's another thing for a small practice to.

Yet, the safety benefits are compelling. Coming from the consumer perspective, we know it's so much easier to "misread" a hand-written entry than it is a computerized one.

Stefani April 28th, 2009 01:31:09 PM

"What will we do if the power goes out? We're not big hospitals with generators, right?"  Oh, please.  A generator big enough to run a small computer system runs $250 at Lowes; whole house systems start at $3500.  IMO, every business and home should at least have a small one.  "And if the phone lines go down, too? Where's all our stuff now?"  Any decent system would store locally and backup to an offsite, preferably accessible, storage instantly and periodically (for those outage issues).  "Where are the backups? In the event of a hurricane?"  Lots of inexpensive and reliable off-site storage these days with multiple back ups in different locations these days.  No valid excuse there.  "And what if I can't type? I mean...zero typing skills."  Aw, come on, typing is easy to learn but, if you just really won't learn it, there's always the peck with a stylus on a keyboard method.  Or you could opt for the really, really easy write on tablets that have improved so much they really can be used these days.

Now, let's get to the reason people really don't want to go electronic.  Our federal courts have been using tape recorders for years.  It's wonderful, they tape everything in the courtroom and, if it needs transcribed, you order it.  You can listen to the tape if you like as well.  The district courts in Houston (amongst many, many others) still persist in having a court reporter record.  The use of court reporters is far more expensive but the judge gets to pick ther reporter.  And, guess what?  The record doesn't always reflect what actually happened!  The real problem with going electronic is that there's a real record that can't be easily fudged and everyone knows it on some level whether they admit it or not and who really wants that level of scrutiny if it isn't forced on them?

PJBoosinger April 28th, 2009 01:33:50 PM

I, for one, don't buy the "it's expensive and difficult" excuse.  I ran my law office on a System 6 Mac SE and standard software plus FileMaker.  I'd be quite surprised if y'all do anything FileMaker can't handle and you have the luxury to design your own databases instead of having to find work arounds that always exist in canned software (that's usually grossly over priced).

PJBoosinger April 28th, 2009 01:40:21 PM

Imagine when we reach the day where technology can be utilized from the home direct to the Vets office via voice and hd video.

Evet April 28th, 2009 01:41:41 PM

Karle: Can I quote you for an upcoming article for Veterinary Practice News I'm writing? Your second paragraph is most interesting and informative. If so, can I get your location and can you contact me through the 'contact us' button located at my navigation bar? No sweat if not but it's good stuff.

Dr. Patty Khuly April 28th, 2009 01:48:47 PM

We talked about computerized records in a discussion during our business/management course. One trick with computerized medical records is that, in order to qualify as a legal document, as all medical records should, the system must be unalterable (i.e. you can't go back in the medical record and delete something). Surprisingly, not all records systems have this feature (cough cough Avimark).

Megan April 28th, 2009 02:00:27 PM

Megan, It's a little more complex than that but one should certainly be able to see any additions, corrections, alterations, and/or deletions; nothing should actually be replaced or disappear in such a way that it can't be easily recovered (although it might be "hidden" so as not to confuse anyone currently using the information).  Now, if you really want to preserve everything, you should get a program that monitors and records keystrokes and archives them all :)

PJBoosinger April 28th, 2009 02:15:28 PM

Hello Dr. Khuly, I would like to share with the group how the American Animal Hospital Association is addressing electronic health records and standardized diagnostic codes. AAHA has been meticulously developing and mapping standardized diagnostic codes for the past few years. Although it has been a long process, giant strides have been made. The Association understands the impact the electronic health records and standardized diagnostic codes will have on veterinary medicine. Done properly, all veterinarians, clients and patients will greatly benefit from this project. Information gathered through these terms will improve evidence based medicine by tapping into everyday practices and cases. In order to get the feedback needed to make the monumental project viable to practitioners, AAHA created the Electronic Health Records Task Force and the Diagnostic Review Board, comprised of volunteer leadership from practitioners in small animal practices. They actively debate the various view points and ramifications of each term. Limited beta testing has been underway with the terms. Currently, the terms are being mapped to SNOMED. Once the initial terms are completed, AAHA will turn them over to the individual practice management software providers to be incorporated in their systems. Last week, AAHA hosted the 2nd annual practice management software summit to discuss findings with the software leaders. Every practice management software company was invited (the vast majority of them attended).

Jason Merrihew April 28th, 2009 02:55:17 PM

seems to me the solution to power failure is to simply print the electronic medical record after each visit/update and keep a hard copy as well as an electronic one.

Or subscribe to a big fancy online storage solution that of course would "Never" have a user problem or power failure.

LorriM April 28th, 2009 03:23:26 PM

LorriM: That is indeed doable. I now store all my personal files online through Apple. It works for my small system. There are great powerhouses out there that do similar things for larger enterprises. We should have only minimal fears of widespread system breakdowns with our current technology.

Dr. Patty Khuly April 28th, 2009 03:28:03 PM

Jason: I am aware of the strides you have made in this arena. In fact, it's a driving factor in my deliberations with my employers. We shouldn't leave it up to the Banfields of this word to mine data for their own personal gain and occasional contributions. Though I welcome their transparency on significant occasions (i.e., pet food recall), the entire profession needs a makeover in this department and it seems as if AAHA is leading the charge. Kudos. 

Dr. Patty Khuly April 28th, 2009 03:30:30 PM

LorriM, sure...my husband I are probably in the computer geek category but...there is a solution for power failures, and I just used it a few days ago, during a thunderstorm, where the power went off.

My cottage is solar powered...which is probably the obvious solution. Alas, here at home, we're not so lucky. And being in "the country" (sort of), our power does go out, from time to time. (Maybe 4 or 5 times a year) Since we also have VOIP phone service, that means that, if the power suddenly goes out, not only do we lose any unsaved data on our computers, but we also lose Internet access, thus our phone service, as well.

As soon as we realized this, we high-tailed it to Best Buy, and purchased power back-ups. One is dedicated to our home servers and related devices, and one is dedicated to our main, 2TB computer. Each provides up to 4 hours of back-up power but, the main benefit, is it keeps the computer running long enough to save any open documents. I think they were about $200 each.

Marjorie April 28th, 2009 03:31:50 PM

PJ, re:

" The real problem with going electronic is that there's a real record that can't be easily fudged and everyone knows it on some level whether they admit it or not and who really wants that level of scrutiny if it isn't forced on them?"

Stefani April 28th, 2009 03:45:14 PM

oops, PJ the rest of my comment lopped off. I was just going to say that in a presentation on clinical decision support systems (which issues alerts to doctors re: interactions and possible dx, etc) the presenter said that one of the first questions he got was HOW TO TURN OFF the audit trail.

Stefani April 28th, 2009 03:47:49 PM

Interesting! When I finally went for routine med work a few months ago, whoa---the doc was typing everything on a computer the size of a 10" book! No charts, no pen & paper, nothing!

Would never work for me with 2 finger-typing! What a way to request "instant records" before leaving the clinic or downloading from a website (lab results, etc) once home!

I can see changing over as computer eqipment becomes old & out-dated.

Barb A's blog

Barbara A. Albright/NH April 28th, 2009 03:47:50 PM

there are a number of different obstacles, many of which have been covered. Some of the most challenging are the "resistant to change" category. Others are logistical, and still others pertain to maintaining the veracity and security of records. You give the example of online banking. Try to imagine how much it costs to pass the different audits these institutions bear, bi-annually, if not quarterly. If a veterinary clinic does not have backup power, isn't each surgical procedure a bit more dangerous? On the other hand, I would argue that a $200 generator can burn up your computer. While not so much any more, computers are sensitive to frequency variations, and cheap generators do not have power filters. Not to mention the brown-outs and surges as microwave ovens and space heaters get plugged in. Relying on off-site storage and computing resources is risky to the individual instance; the only way to mitigate the risk is to "know the lingo" enough to know when you are being sold a bill of goods. Many managers tend to stick with what they know, it is their butt on the line, after all. Human health insurance companies have a vested interest in the medical profession adopting standard codes. I do not see the animal health insurance companies being a big enough player, yet. The codes Mr Merrihew refers to will be great, if you can get through th cost and resistance to change. In my area, few practices are large enough to afford the type of education, planning, training, implementation, and maintenance costs a truly viable, reliable, secure and trustworthy system requires. The companies that process credit card transactions (for example) are audited twice a year by an external auditor. They audit themselves at least in advance of each of these. I am not suggesting veterinary records need this type of security (wait, maybe I am - PII is involved), but use it as an example of how a FileMaker solution could end up being more costly. No upgrade path, no software and data lifecycle management, etc. Implementing change is one of the biggest aspects of the job(IT), because of the resistance. Which is so ironic - bang head on wall ironic - because the only constant in _anyone's_ life, is change. Stefani remarked on the users wanting to know how to turn off the audit trail in a system. This is a common underlying resistence theme from people in charge. Knowing how to "play" a system is how they got to where they are. Implementing an apparrently "fool-proof" system takes away some of their power. There have been some funny shenanigans related to this angle over the years! The biggest payoff in automating the maintaining of data(records) is accuracy and efficiency. A business should invest in technology as soon they find it in the budget. But it isn't as important as the reason they're in business.

eli April 28th, 2009 05:29:48 PM

Now, of course, just to play devils advocate here for a minute....I feel okay in my vet knowing how many pets I have, but that on a data base some place?...where some idiot paper pusher might make a judgement based solely on statistics in front of him on a computer screen?

or knowing that cats x y and Z don't have current rabies vaccines without knowing the "why"....or having the intellect to read the entire file to find out why...simply just going by some reminder flag in a software program?

it could become just a little too 1984.....and I feel we have already become a little too 1984 by choice without completely thinking out the consequences.

and I know that the stored information shouldn't be compromised, or even seen and judged, but really what guarantee is there that that doesn't happen....some companies word on it?

Marjorie...solar is awesome....battery backups....not so much, but they work okay most of the time. We had voip too until the kids outgrew the need for so much teenage phone time, now we just have cells.

LorriM April 28th, 2009 05:32:12 PM

LorriM: You would have to take your veterinarian's word for it. Selling data is currently verbotten in the industry (there was a recent discussion of this at the AVMA level). And your vet's records would be individually maintained--for the moment, anyhow. And I think most vets would be resistant to any change from that standard. BIG TIME. 

Dr. Patty Khuly April 28th, 2009 05:36:50 PM

Resistance to change has many reasons, especially in small practices. We have at least 1500 active clients and maybe another 100 who bring in animals every few years - and only one vet. The only part of our files that are computerized is for billing purposes - codes/prices for procedures and products - and it's not going to change. The time it would take for the vet (or someone else to transcribe his chicken scratch) to type full, sensible, legible office visit notes is too long or would cost him more $$ paying for transcribing time. He can read it on the record when he needs to refer back to it, and sometimes he does use code words to denote animal or owner behaviors that he'd rather they not be able to read - and it's not for nefarious reasons, it's just smarter not to possibly hurt a client's feelings if they try to look at the record when he's not in the room (and the assistant is also out). He does all appointments and surgeries, spends 2-4 hours beyond office hours doing calls to clients, and he is often at the front desk and/or pharmacy, because he has to have control of everything that goes on (easily working 55-60 hours a week). While this level of personalized service is higher than many places I've seen, it makes for a vet who knows what he's doing and can do it quickly and effeciently, but has no time to learn to do it differently, because this system works to his unique specifications (and would never allow the time, let alone spend the $$ to train staff to do it differently).

KateH April 28th, 2009 06:26:14 PM

KateH: When it's only one vet that's great. But if you see this systems, it's all so point and click and easy that the time involved is negligible. Plus, when you're like me and you do a lot of referring (I'm in a major metropolitan are) it's priceless, the ability to send legible records. My 2 pennies.

Dr. Patty Khuly April 28th, 2009 06:37:14 PM

I'm sorry, Dr. K. I didn't mean to say that I was against the idea - I'm not. I was just saying that the resistance to change point is very valid, especially in small practices running on small (ish) profit margins. (The vet I work for is super crazed about 'time=money' issues, and his having to learn something different and training staff too, is not something he's ever gonna spring for. Just getting billing/reminder software only happened when he finally had to admit it would be faster and cut costs to not hand write everything. That happened after 15 years into his owning his own clinic.)

KateH April 28th, 2009 06:56:03 PM

I work for a Banfield, and I honestly don't see how practices run WITHOUT computerized medical records - esp. a higher volume practice. I can't imagine having actual "charts" in our clinic...which I know makes me sound spoiled, and I suppose I am. I think it's a shame my pets' medical records are probably more thorough than my own! This is at least one area where Banfield has it right, IMO.

anna April 28th, 2009 07:21:15 PM

I am so glad to see this thread.I preach the Gospel of Good Records to every pet owner/guardian I run into and implore them to use that as a MAJOR criterion for choosing a vet. My own personal choice is that I do not even go to a vet who does NOT have computerized records, at least partially (meaning, there may be a handwritten chart, but there must be a computerized itemized invoice that lists treatments, drugs, etc.). Ideally, I would love everything to be computerized from the top down. My current vet feeds the information on the spot after every visit. I won't go into my whole horror story here again, but the vet who mistreated Suki had the WORST records you can possibly imagine. No big surprise. He basically violated every recordkeeping statute of the Texas VPA, and -- I'm sure you know where this is going -- the reviewing board vet (singular) let him off. No violations found. No disciplinary action for records that contained only one dx - arthritis. Suki had CRF, anemia, hypokalemia, hyperphosphatemia, and god knows what else, and not ONE of those dx were recorded over a period of three years. Also no Rx of home subQs, omissions of names and dosages of Rx drugs, NO record of a single discussion with me, no recommendations, no recheck dates, repeated omissions of weight and temperature (he recorded temp twice in three years), and NO notations of any PE. Except one time - after one PE the vet wrote "ok." Yep, three years of that crap. So, as you can imagine, records are a HUGE thing with me, and should be with every guardian. They are a big part of what we pay for as guardians, and we are entitled to complete and accurate patient records. PS: In the vet's deposition in 2006, when he sued me, he stated that he doesn't have computers in the office. He probably still doesn't. He did this to Suki TEN years ago, and this guy STILL doesn't use computers. Three guesses why - he can't use White-Out on a computer like he did on Suki's original chart.So watch those records - they always tell the tale. As I say on my site - show me lousy records and I will show you a lousy vet.

Julie vetabusenetwork.com April 28th, 2009 07:41:30 PM

Julie, just the presence of computers as record-saving devices will not magically make complete info on observations, diagnoses, and treatments appear. If someone doesn't put the info down, on a handwritten chart or in a computer file, that's the problem. While I can see where computerized files could help with ease of use (by staff and clients), they are not going to make a difference if they aren't used. That vet you speak of would have been a bad vet even with computers in his office. Our handwritten records are quite comprehensive, even if some notes look like this: 4/28/09 - 84# 101.6 mod pain lf rear hip dys? rec xr HW neg - the computer billing includes office visit, HW test, Sentinel(6) -- it covered everything that happened, and the record can be pulled just as fast from the cabinet if anything needs to be checked.

KateH April 28th, 2009 08:00:42 PM

Sorry, KateH, but it sounds like your doctor needs to get back to what a doctor should be doing: diagnosing, prescribing, and doing surgery.  Front desk and pharmacy are for the techs and assistants.  Once we got our doctor to realize that, our practice has had phenomenol growth.  We now have 9 employees for 1 doctor.  We are highly trained, and a great team, with our goal each day to facilitate the doctor in providing great care for our patients.  And, yes, we are computerized, though not completely paperless.  Working on it!  He keeps better records now with a computer than he ever did without.  And he is a two finger typist!  The best thing - he gets to spend more time with his family now, because he doesn't try to do everything.  Now, if we could just find and hire an associate - anyone know a vet who wants to move to rural Michigan?  We are actively searching!

Sassy April 28th, 2009 08:30:09 PM

Julie, re the whiteout: On paper records, you can pretty much tell when white out's been used. In electronic records, things can be changed retroactively with no visible sign. For example, in my case, there were manual records, so I hired a handwriting analyst who agreed with me that the initials in the record were likely forged by the vet. (Which was no surprise since the original handwritten record I'd seen had ** disappeared ** quite magically.) One concern I have with electronic records is: without the audit trail, modifications are not apparent (you can finegle the system to change the date if the records are dated), audit logs can be overwritten, and therefore the only way to prove that records have been retroactively modified is to get legal possession of the hard drive (or have it subpoena'd,) and hire a computer forensic analyst to analyze the hard drive. Since I work in computers I know there are lots of ways to erase audit trails if you know what you are doing and only a computer forensics expert could tell.

All the more reason to get copies of the records every time you go (to either the doctor OR the vet).

Stefani April 28th, 2009 09:32:18 PM

Stephani, It's the first question I asked as an undergrad accounting student and the most frequent question I got from clients :)

KateH:  Should your vet really be putting ANYTHING in the records that they wouldn't say to to the client?  I've had a couple of human docs pull that and incur my wrath because I used to be a hospital volunteer (and, as it turned out, they were wrong and delayed my diagnosis with that nonsense) and could read those notes.

Eli, have you used FileMaker?  I could port my 20+ year old Mac files to a current PC version of it if I wanted.  It's far easier to port and upgrade than any canned specialty software I've ever seen; mostly because the vendors of the canned specialty software have a vested interest in making it difficult to change; once they got you, they don't want you to go elsewhere.  Does have a cruddy audit trail but then I like the keystroke monitors for that; let the opposing accountant/attorney/IT folks muddle through them :)  Besides, Stefani is correct, there's ALWAYS a way around the audit trail in electronic records, just as there was in manual records.  Need to get those records when you can.  Just like you have to print web pages before they disappear :)

PJBoosinger April 28th, 2009 11:00:18 PM

Dr K,

I do trust my vet....but since he combined out to become part of a referral service providing much higher services for much high prices, I don't trust the higher ups....yes, in a way it's still his practice, but in many ways it's not....and when it is no longer a small personal anything, money become motive and I can't trust what I don't know.

I'm glad to hear that selling data is verbotten, but how long is that going to last? particularly if big business such as pharamcuticals decide that the data is valuable...as more vets graduate in debt to the hills that temptation is going to rise regardless.

seriously I can see it now...some type of irresistable carrot on a string...maybe even wrapped up to look alturistic...if only you tell us what antibiotic is most prrscribed, or what % of people opt for a FIV/FELV test, or what is your best selling flea product...and how many cases of parvo did you treat this year...and if you give us this information, well, we'll support the s/n of 100 strays...or we'll donate xxx dollars to a general emergency fund...or even worse, we'll give you 10 free cases of xyz drug to use...

I could think of more, but the paranoid portion of my brain is tired tonight. :)

If I really didn't trust my vet, I wouldn't use him....he really is a good person.

LorriM April 29th, 2009 12:04:44 AM

LorriM, I have some of the same concerns.  In an electronic world, we have little reasonable expectation of privacy.  So far, the information is spread through multiple sources but I expect one day it will be functionally accumulated and I expect that day isn't as far off as I would hope.  I've come to the conclusion that we'll have to promote more rationality in data and people analysis because that data accumulation is coming and there will always be those who want to police others to the extreme.

PJBoosinger April 29th, 2009 12:30:46 AM

Stefani, there's no doubt that if a vet wants to alter ANY records, whether handwritten or computerized, he will find a way to do it (or get others to do it for him). It's not like a computer is going to make an unethical vet ethical.  And yes, Kate, I know that computers have no magical ability and I also understand that the information has to be inputted by the human, and if it's deficient in the first place then it's not going to make a difference. Good vets have been keeping good records long before computers were around. I just think that if a vet makes that kind of investment in money and training, he or she *might* be more likely to use it, and if used properly, it's been my experience that the computerized records are far more complete because vets usually type faster than they write, and the legibility factor is increased. And I tell everyone I know to get copies of records after EVERY visit - if a vet is going to tamper with them, whether they are handwritten or electronic, that vet is going to have a problem explaining why his copies are different from the ones his client has. For those who don't get copies of their pet's records until after something has gone terribly wrong, records of ANY type can be altered by the vet and the staff and the client doesn't have a leg to stand on.

Julie April 29th, 2009 05:08:38 AM

Wow. This post amazes me. I have been to quite a few clinics in the last few years, and all of them use computerized records (mostly using the RapidVet software - http://www.rapid-image.com/Default.aspx?tabid=73 ).

actually, it looks like the trend now is upgrading the X-ray/US machines to digital, so the results are attaches as an image to the digital patient record.

On the other hand, human docs have been using computerized records for years here. Makes for much easier life when going to the ER.

And I still remember my old family doctor who retired at least 5 years ago, hunt and peck his way around the keyboard when updating records...

Xslf April 29th, 2009 05:45:56 AM

PJ - I have not used FileMaker, itself. And your assertion is valid, let me clarify my comment regarding "No upgrade path, no software and data lifecycle management, etc".

PJ's FileMaker solution fits her office to a "T". Because she built it that way, and it addresses the automation needs of her office. And this is how it should be for small offices.

It is presumptious on my part, but I daresay this solution is not a full-fledged case management system, such as would be seen in larger law offices.

My point is, that should there one day become a need for all of PJ's records to be incorporated into the case management system of a larger enterprise/office/association, how much would it cost to do so? Think very unique data constructs. (And I have been involved in just such a case, and support the case management system today.)

And if I might speak a little on auditing database activity. The capability is native to all modern enterprise ($$$) database systems. There are third party ($$$) auditing systems that can be added to applications to provide independant auditing of activities. A State Trooper recently lost his job/was penalized because an audit on background search activity revealed searches without cause on local celebrities/individuals of personal interest. The system and the audit functionality were as a result of recent upgrades. Whether information activity can be hidden/deleted is a matter of risk to the holder of the information. For example, the pharmacy that concocted the incorrect dose for the 21 polo ponies is hoping that its record-keeping system can be shown to be reasonably protected from tampering/user error. Their information systems are safeguarding their business and their liability. Wanna bet a pharmacy tech can fanagle their system, for work-arounds to known issues? Not when their are millions on the line.

As a funny aside, PJ gave us a great example of how to obfuscate information, through the expedience of TMI - the keyboard logger. While definately a legitimate audit trail, it is one of the longest, winding-est trails in audit technology!

I have tried to keep this short, as my intent had been to add to Katzke's points regarding the hardware.

eli April 29th, 2009 01:33:16 PM

Sassy, if we could get him to just do 'the doctorin' stuff' it would be lovely for the rest of us, but I was trying to, nicely, say that he's a major control freak, and has been his entire life, and will continue to be to the end. He's also extremely aware of costs (I'm again trying to say that nicely) and runs a cost/benefit analysis (on how it affects his bottom line) on everything he does. Now, I'm not saying he's a bad vet - he's not - he's just, well, different. He doesn't spend a lot of time on family (divorced), so having more time, well, it wouldn't change him.

PJ, the private comments generally refer to a pet's behavior that the client is in denial about. If you remember the post about aggression/biting...well, some clients we can put a yellow highlighted, big, block letter BITES, on the record, and they would be fine with it. Other clients get upset/ticked/whatever, and so while the vet and staff know what a certain skwiggle in a certain spot on the record means, the client doesn't. There are some clients with medical issues with humans in their family that might have a bearing on the pet's health (usually this is an overfeeding issue because of someone in the family with Alzheimer's or something). We don't think that needs to be blatantly written out, but we can nicely ask, "So, how is your mom doing?" not just because we're politely chatting, but because this can elicit a less defensive response than, "So, is your mom still sneaking food to Chalmer?" While different places handle these aspects differently, it isn't meant to deceive. Does that mean we're doing something bad or wrong with their records - no. It means that we handle some people differently to maintain a sometimes delicate relationship with a client.

KateH April 29th, 2009 03:25:13 PM

Eli, Thanks for the clarification and info.  I know I'm out of date in many tech areas.  Part of the reason I fall back to FileMaker is it just keeps working.  My most recent project was to consolidate our condo records from 4 different specialty software databases into one and then export it to yet a new one that the new manager wanted to use.  I may well have developed some additional "jade" to my perspective in the process.

For a brief period of insanity in accounting training, I thought I wanted to become an auditor.  You have to think like a criminal to catch them so, yeah, I know how to obfuscate a file really fast.  Frankly, most of my clients had other audit software as well as the keystroke monitors and it just depended on how nasty their lawyer was which one we gave up.  Rude, nasty, mean lawyers and their clients get the long winding tour :)

KateH, Get hold of his cost/benefit analysis and show him how to increase his bottom line by doing it your way.  I'm cheap and a control freak too but extra dollars on that line are persuasive :)  I hear what you're saying about the notes but it often becomes tempting to put things there you might not want to explain later so just try to keep everyone on the "right" side of that line.

PJBoosinger April 29th, 2009 04:45:32 PM

PJ, as if he'd let anyone see anything, ha,ha,ha! It's not worth the hassle for that battle - I only work 12 hours a week there and learned 16 years ago that trying to change him was a waste of time. As I said, he's a good vet. Not as good as some, but better than a large number I've met, so I'll just do my best to deal with his idiotsychracies. ;)

KateH April 29th, 2009 04:59:47 PM

LOL, you did notice I said "get hold" rather than "ask for"?  Yep, know the type well :)

PJBoosinger April 29th, 2009 06:25:31 PM

LOL, you did notice how I spelled that last word :))))))))

KateH April 29th, 2009 06:27:11 PM

This is a great discussion, and one that is being had in many different industries (dental and medical, too). Computerized health records are invaluable and necessary in busy practices. Our vet has been digital for many years. Additionally, when I opened my HealthVault account, I discovered that I also could create files for my pets. So now I can keep up to date on my cats' vaccinations and teeth cleanings and not have to wait for the little reminder postcards that invariably come in the mail. It's also enabled me to confirm that my records match my Vet's. I can appreciate that there are back-up questions for the practices, but that shouldn't prevent the practice from going digital. I work with a company that works specifically with dental practices, providing off-site backup, as well as ongoing system diagnostics. It is not expensive, and they often know when a computer is beginning to fail before the user does, and can call the office and tell them the repair they are on their way in to complete, so the system never goes down.

Lori April 29th, 2009 10:55:29 PM

Ok, today is the first time I have a template on this blog! If I saw the human med "Macbook" correctly, it had pages of preformed templates to check or put letters inand a couple of diagrams. This would cut down all the hand-writing and abrev. could still be used. Maybe even a date/time-stamp, vet sig stamp.

As far as alterations go, OMG, how many people ever get a copy of records, until something prompts them? It is shocking to learn that things are written that may never have been discussed or possibly even fabricated!

I would like to know if a receptionist has any legal or ethical right to be filling in records to include medical concerns, reports, or prescription dosages?? Any thoughts?

Forgive me, I'm acting like a kid & want to try out the gadgets:

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Barbara A./NH April 29th, 2009 11:31:29 PM

Way (way, way) back when, I was a clerk.  Clerks (and other staff members) are often blamed when things go wrong in professional offices and they rarely have the right or even option to put anything in the file.  Any time I saw hinky stuff going on, I made dated notes and take home copies to CYA my own rear.  You have to tuck these items away because no one should see them that isn't authorized but it always put me in the position where, if sued or blamed or subpoenaed, I could cough up evidence.  Had one boss early on who was kiting checks to the IRS and they bounced.  He then attempted to blame the VP (his own sister) and the bookkeeper (me).  We we're the ones who ended up in federal prison.

KateH, I missed that! How funny!!!!!!!!!!!!!!!!!!!!!!!

PJBoosinger April 30th, 2009 04:47:56 PM

PJB: Whhhattt? Did I understand you correctly? You took the heat and ended up in the penn? eegads, don't even joke like that! Or...is that where you got your law degree?

Yuppers, does seem to me that only a licensed vet should be putting in those kind of notes. Hmmm, maybe I should put up more pages of "stuff". But as it is, not many go beyond a couple of pages....

Or would a page of all the federal & state laws highlighted be more appropriate & interesting? Forgive me, I had a pissy day at the PO!

Barbara A./NH

Pocket's Story from NH April 30th, 2009 06:32:59 PM

No, ratted him out and she and I walked.  "we're" should have been "weren't" LOL, fumble fingers. I think I must be coming down with something. :)  (Afraid my law degree is from a yuppie private school.  They're probably sorry they ever let me in; not supposed to "make waves".)

Formatting, highlighting the laws along with citations is very helpful to non-lawyers.  They'll get to your site with key word searches and those types of searches rarely (almost never) get you to the laws.  Careful not to interpret or give advice or some twit will likely try one of those nasty SLAPPs on you.  BTW, legal pleadings are public records so, if you can get copies of them where lawyers are explaining a provision to the court, THAT you could post or quote from.

PJBoosinger April 30th, 2009 10:39:56 PM

Thanks PJB: Someday I'll have 50 or so pages, for the CSI inclined, all the white-outs, missing forms, records, connection between parties, false information in writing, contacts I made, responses, phone records, FOIA requests. Oh yes, a real pretty picture will unfold, 2 years of unbelievable, blatant disregard for a human-being & her pet. No doubt, a huge undertaking to archive & post!

Barb A./NH May 2nd, 2009 10:56:25 PM

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That's why the resistance to computerized medical records seems incredible to me. I just don't get it.

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