Modern filing systems

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alking about the need to put medical records in electronic form is easy.

Actually designing and implementing such a system is another, far more complicated matter, as officials and constituent members of the District of Columbia Primary Care Association (DCPCA) are learning daily.

With $5 million in funding supplied by the city, the agency's Medical Homes division has embarked on a pilot project to digitalize procedures in six of its 10 clinical centers. The centers operate 21 sites serving the underinsured and people without ready access to basic health care. The project's long-term goal is to be able to link the centers and, later, electronically connect all the centers with local hospitals and other medical facilities to form a regional network.

The District three years ago gave the agency $21 million to build the centers, known as Medical Homes — a concept that allows clients to think of the centers as facilities where they always are welcome. Some 26,000 patients were being served at the time by the agency.

"Primary care is preventive care," says Orlene Grant, director of Medical Homes Programs and Special Projects, who is overseeing the project. Any talk about the computerization of services, she insists, "has to get back to the human factor" — how a so-called paperless office will better serve clients.

The first center planned to operate this way will be the Whitman-Walker Clinic, expected to be wired fully in November. Next in line will be Bread for the City, So Others Might Eat, Mary's Center, Family and Medical Counseling Service, and La Clinica del Pueblo. Four others will follow when money becomes available.

When the system is up and running, centers will be able to register patients and chart appointments and diagnoses electronically. The system also will be able to link Medical Homes clinics with Medicaid and Healthcare Alliance offices.

"The potential for better patient care is tremendous," Ms. Grant says.

It's not a novelty in Washington to find physicians in private practice going this route: installing the necessary hardware and software to improve record-keeping and billing procedures. Few would dispute the advantage in terms of efficiency alone, both as a cost-saving measure and, more importantly, in the ability to have medical histories readily accessible with key data in hand when treating patients.

The private Washington ENT Group at 2021 K St. NW, for example, went largely paperless seven years ago. Physicians there greet patients using hand-held wireless devices similar to laptops or personal digital assistants that are comparable to the old-fashioned chart and cumbersome files. All past information pertinent to the patient is available at the click of a few keys with the help of a stylus. Prescriptions and lab-test orders are handled electronically as well.