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Database Application Helps Physicians Eliminate Billing Delays

by Frank Yacano, Director of Business Development, SYWARE, Inc.

Database application helps physicians eliminate billing delays
Database application helps physicians eliminate billing delays

Physicians are always looking for ways to reduce paperwork. One area that has long been considered a burden is the billing process, where timeliness and legibility are major issues for many physicians.

Dr. Scott Sher, an anesthesiologist practicing in Phoenix, Arizona, has developed a technique for creating billing records using handheld PCs that provides physicians with significant time savings compared to paper forms. The new approach also provides physicians with their own electronic log of billing records as protection against discrepancies or errors.

Each time Sher cares for a surgical patient, he must submit a billing form to his billing company. The traditional method has been to physically write the details on a paper form, which contains over 24 fields that must be completed. The inefficiency was apparent, involving repeated writing of standard details such as hospital name, surgeon, and diagnosis. In addition, while this approach creates records for the billing company, it did not provide the physician with a log of billing records for their own reference. "This screamed out for a database application," says Sher. "I was just slapping on the billing slips and giving them away."

He wrote an application in Microsoft Access that allowed him to keep track of billing records on his desktop PC. However, this meant that he had to wait until he came home before he could enter the information and then print the billing slips. Since his schedule is extremely hectic - routinely coming home at 10 p.m. and waking at 5 a.m. - it was often several days or more before he had time to sit in front of his PC. As a result, his billing activity was falling behind.

Sher recognized the potential of handheld PCs to assist with billing tasks by allowing him to capture data at his convenience, even in the operating room. He chose the Pocket PC environment because he found that large database applications developed for the Palm operating system had a tendency to crash. Sher purchased an iPAC Power PC, which he selected because of its large memory and fast processor - major advantages when running a database application. He then had to find a program that would allow him to replicate the billing form on his handheld device while synchronizing with the master Access database on his desktop.

Application Development for Non-Programmers
He discovered a software tool called Visual CE® from SYWARE ( that uses intuitive drag & drop controls to allow rapid building of form and database applications on Pocket PCs and Windows CE handhelds. Forms created in Visual CE form serve as the front end for a handheld database that is also part of the application. This database synchronizes with Microsoft Access, allowing data to be readily exchanged between handheld devices and the Access application running on the desktop.

Sher used Visual CE to create a handheld form to capture the data required on the billing record, including patient information, diagnosis, surgeon, hospital, procedure performed, and several check box modifiers required by the insurance company. Drop down lists and other shortcuts speed data entry while allowing all possible selections to fit onto a palm-sized form. For example, Sher has worked with over 110 surgeons since he started using the application. To enter a selection in the Physician field, he taps a letter from an alphabet keypad to get a list of names beginning with that letter, and then taps the name he wants. The doctor's name is then entered into the field without having to physically write it.

Tapping through Billing Records
After completing a case in the operating room, he enters the information in the database entry form on his handheld. He taps his way through the check boxes and drop down lists, creating billing records in a fraction of the time required to fill out forms by hand. "The time savings and convenience are tremendous. I can enter data anywhere - in the operating room, in a cafeteria over a cup of coffee, or even waiting for an elevator."

When he gets home, he drops the handheld unit into its cradle, and the handheld application synchronizes with the Access database on the desktop. During synchronization, case records created on the handheld are downloaded to the desktop, and updated tables are copied from the desktop to the handheld as content for drop down lists on the form.

Sher then double clicks on a desktop icon called "Print New Charges", which automatically prints all new billing records in the Access database. These records are in the same format as the traditional billing slip for submission to the billing company. "I print the new billing records with a single mouse click, and they're ready to go," he adds. "The billing company loves it because it's incredibly legible, and every bit of information is where they expect to find it."

Automating Routine Tasks
Sher also created several macros in Access that automate housekeeping tasks both on his desktop database as well as on the handheld. One of these macros is used to update the tables that provide content for the drop down lists on the form. The desktop database contains tables of surgeon names, medical facilities, procedures, diagnoses, and other parameters. During synchronization, as new case records are downloaded from the handheld, the macro automatically updates the desktop database tables with the new data. The tables are then uploaded back to the handheld to update the list tables.

The macro procedure also scans through all records to eliminate duplicate entries. For example, if he worked with a new surgeon several times in one day, the macro picks the doctor's name once from the handheld records and adds it to the Physician table in the desktop database.

A second macro periodically cleans out old case records from the desktop database and dumps them to an archives file. Matching records are also deleted from the handheld. The tables of physicians, facilities, procedures, and other parameters remain intact even though the records have been removed.

Sher also solved the problem of how to keep track of records that have not been billed, while avoiding duplicate billings. He created a field in his desktop database called "Billing Flag," which defaults to zero when a new case record is entered from the handheld billing application during synchronization. A third macro prints new billing forms from database records that have zeros in the Billing Flag. The macro then changes the flag to a 1 to mark the record as billed. On the next synchronization, these newly billed records are backwritten to the handheld so they are not billed again.

The solution is also much more flexible than working with paper forms. Drop down lists can be modified in seconds by simply updating the database table. In addition, the drag and drop functionality of the handheld application allows the easy creation of new fields to meet the needs of the billing company as well as the physician.

Maximizing Billing Efficiency
Sher recently presented the handheld application to his group of over 100 anesthesiologists. He reports that enthusiasm was very high, and his Pocket PC application is now being evaluated as a solution for the entire group.

The ultimate goal is to migrate the practice to a real time wireless billing solution using handheld devices. Another SYWARE product called mEnable allows real time interactive access to server databases from a handheld PC. Physicians will be able to tap in billing data from the operating room or any other convenient location, and the records will go directly to the billing company for immediate processing. As Sher points out, "Every day you save on billing is real money."

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