Mark Culpepper Develops Medical Records System of the Future

By Shep Montgomery
20 Feb 1995
Mississippi Business Journal; Page 15
Copyright 1995, Mississippi Business Journal

Jackson, MS. Just think of what it would be like if the technology was developed which would actually allow physicians, many of whom are more burdened by paperwork than patient loads, to enjoy their practices again.

Well, to hear many tell it, the future is here now, and it is being developed right here in Mississippi.

1.2.1 Micro, the rapidly-growing Jackson-based computer consulting firm, is in the process of developing On-Line Care, a computer program which provides full automation of the record- keeping functions of a doctor's office, from the changes in a patient's records to full document storage, said Mark Culpepper, director of remote data services at 1.2.1's Nashville office.

Although the technology necessary to get On-Line Care off the ground only took hold in recent years, the idea behind On-Line Care actually took place when Culpepper began following his physician- father around the hospital. At an early age, Culpepper observed the extremely paper-intensive nature of the medical profession, where simple tasks such as updating a patient's chart seem to take forever and an army of medical transcribers constantly labor on paperwork that often seems redundant.

"To get an updated chart, particularly in a hospital environment, may take forever," Culpepper said.

It was those early experiences observing the medical profession's paper chase that gave Culpepper an idea for a career goal: "Why not provide a physician or a nurse with a tool that could make the job easier?"

A graduate in communications from the University of Southern Mississippi, Culpepper worked with Xerox for several years when he began working on the ideas which eventually would result in On-Line Care.

In early 1993, Culpepper began to study emerging technologies which could contribute toward the creation of the paperless office, including PEN-based technologies, which enable a computer to actually recognize the features of handwriting and transform it into actual typed text.

The past couple of years have seen more sophisticated, miniaturized computers which can support such technologies. The first prototypes were those such as AT&T's EO system, a clipboard- like handheld computer whose $3,000 price tag drew few takers. Apple's Newton was more successful, but its small size limited its applications.

Several years ago companies like Fujitsu and Hewlett-Packard began to come out with their own line of computers that supported PEN-based technologies. The new generation of PEN-based computers resemble large clipboards, with full-size screens taking up most of the surface space of the computer. Instead of using a keyboard, commands are entered on the screen using a pencil-like stylus.

Eventually, Culpepper hooked up with 1.2.1 Micro's Randy Russell to get the project off the ground. Russell had been Culpepper 's best friend for the better part of 15 years, and the two had been bouncing ideas off of each other. As it turned out, 1.2.1 had the tools and resources to get the project to market, while Culpepper had the necessary tools to contribute to building the project's sales.

The technology is currently being developed in conjunction with Atlanta-based atHAND Solutions, a firm with over four years of experience in the PEN-based environment. 1.2.1 Micro and atHAND Solutions will continue to work jointly on product development and will divide sales territories in a bid to locate additional markets for its products.

Combining the unique attributes of the DOS environment with the unique attributes of PEN-based technology, On-Line Care essentially is capable of running all of the operations of an entire physician's office, from the time an exam is performed all the way up to when medical records are finally updated.

Because it is not a proprietary system, On-Line Care can mesh with a number of different types of software packages, including standard DOS and Windows-based accounting and word processing packages.

Client-server technology enables each computer to be connected to the mainframe of the physician's office or a hospital.

Each PEN-based computer in the On-Line Care system will be equipped with a wireless radio transmitter so that doctors can roam around the office or the hospital entering data, which is then routed to the system's computer via an access point.

"It would be like the physician having a mini-cellular network in your office, because you're walking around and getting data in real time," Culpepper said.

And it also means that a physician equipped with a remote unit will never be at a loss for a patient's record.

"With On-Line Care, you get real-time access to extremely critical data," Culpepper said. "No longer will the patient have to wait or come back while staff search for their records."

More than anything else, On-Line Care is expected to be a creature of health care reform and the standardization. Regardless of whether health care reform legislation is successful or not, the nation's health care system will continue to be reorganized since the cost of health care services seem to be rising faster than ever.

And systems such as On-Line Care, which promises to streamline much of the ponderous record-keeping involved in today's medical practice, could be an essential element in keeping costs down.

"Like it or not, health care reform is coming, and with it is coming standardization," Culpepper said. "This is one of the tools to provide that standardization."

One of the most obvious applications for On-Line Care is in managed service organizations (MSOs). Developed from the need to provide negotiating power between corporations and groups of physicians, MSOs accomplishes everything from providing business consulting to arranging the purchase of physician's practices for corporations and health care groups, where the physician essentially becomes an employee of the purchasing entity.

1.2.1 Micro plans to market the system to MSOs who are interested in incorporating wireless communications into their operating environment.

On-Line Care is expected to be a good fit with MSOs, because it provides a high level of standardization and a reliable level of information that is essential in running a medical practice like a business. The On-Line Care software basically is organized around the thought process of a routine medical exam with a series of "if then" scenarios leading to a more complex analysis of patient's problems.

A physician using the system enters in the patient's complaints, and based on the physician's findings and diagnoses, the system comes back with a roster of suggested treatments from which the doctor selects based on his subjective professional judgement.

Procedures are entered into the system and categorized according to the entire range of ICD9s and CPT codes, standards used throughout the medical industry for symptom and disease classification used for billing and insurance purposes.

"You can generate reports which show if you are doing your coding right, generating the right amount of revenue, or are you overcharging or are you undercharging," Culpepper said. "The medical profession increasingly is going to have to be run like a business, and this is another means for doing that, by being able to show that you are coding procedures correctly and capturing the revenue."

On-Line Care is equipped with varying levels of security which guarantee that a patient's medical records are only viewed by the appropriate personnel.

The system also can make notes of a patient's allergies and adverse reactions to medicines. Future upgrades of the system may enable prescribed treatments to be cross-checked for future reference.

While a patient's medical records are being updated on the On- Line Care system during an exam, the system automatically updates permanent patient records found in the host file server of the physician's office or hospital in real time, providing the ultimate in data integrity, no matter what happens to the external computers.

"If something ever happens to this computer--the battery dies, or it gets dropped or whatever when they're in the middle of doing this exam, the only thing that they have lost is the time it takes to put the unit down, grab another one, and sign on."

Using the systems' PEN-based technology, the physician can make his own subjective notes using his or her own handwriting at any stage of the examination, since in many instances, it is important that a record stay in the physician's handwriting for insurance and legal purposes. Specialized graphical templates for problems with teeth or lower back pain also are included, which are customizable to any format.

The physician can write and print out a complete prescription using the system, which can be matched with billing and scheduling information. Lab work also can be ordered, which can be compared to work performed on previous visits.

"The system is going to provide you with many, many types of tools, including outcome analysis," Culpepper said. "It helps you to track treatment of that patient all the way through, from the time you first saw him all the way to the time he was cured."

Along with its paperwork-streamlining and labor-saving attributes, perhaps one of the On-Line Care system's most important attributes is the unquestionable "audit trail." "You want to be able to cover your trail if you get sued for obvious reasons," Culpepper said.

Print-outs of records have a time and date stamp on every page-- as well as records of any alterations and the name of the person who did them. Fail-safe documentation also can play a key role in helping physicians to justify insurance reimbursements.

The system comes equipped with software equipped for a base system as well as with further options for different specialty practices such as orthopedic, ob-gyn, and pediatrics.

Already in an extensive testing phase, On-Line Care is expected to be ready for general release and available to the public in March.

Culpepper Ancestry. The father of Mark Culpepper is not currently known by Culpepper Connections! If you know who he is, please contact Warren Culpepper.