It started with a malady common to almost every business environment - Dr. Michael McKinney was sick of paperwork.
When it came time to evaluate his notes from patient sessions, the Lexington physician noticed he was writing up his evaluations in the same basic format over and over again, and wasting a lot of time and medical transcription fees to do it.
So McKinney turned to Gregory Kowalik, a local computer consultant and fellow soccer dad, to help him develop a system that could generate basic medical notes in plain English without a lot of typing to interfere with his patient care. With the help of some outside programming and marketing expertise, McKinney and Kowalik soon created Clicktate, a Web-based subscription service that guides the physician through a series of simple click prompts to create a well-organized and legible report for every patient visit.
Using a PC tablet or computer equipped with Internet Explorer, doctors can select any given ailment or injury, and Clicktate will lead them through a set of one-click updates to take note of present symptoms, risk factors, lab test results, prescribed treatments and more. Clicktate tailors its suggested line of questioning based on the information given, taking note of details such as gender, and allows users to insert their own comments as needed. With this input, it builds an easy-to-read record in paragraph format that can be exported immediately for the patient's electronic or paper files. Clicktate, which is HIPAA-compliant, also custom-designs templates to suit physicians in various medical specialties, but it's the readability, according to McKinney, that gives Clicktate its advantage.
"A lot of what you do from the standpoint of medical transcription or dictation is say the same things over and over," said McKinney, Clicktate's president and medical director, who also works for Central Baptist Hospital and has been practicing internal medicine and pediatrics in Lexington since 1997. "There are a lot of systems and programs on the market right now that will let you generate a medical note. None that I've seen make the note sound like you dictated it."
And the cost savings for physicians using Clicktate as compared to traditional medical transcription expenses can be considerable, too. Clicktate charges a monthly flat rate of $35 per provider for unlimited access, or $420 per year. Typical transcription costs, by comparison, can range from $15,000 to $25,000 per year per physician, McKinney estimates.
"If you're talking about a practice that has five or six doctors, it could be huge," McKinney said.
Physicians as a whole have been somewhat hesitant to embrace the use of electronic medical records, or EMR, systems, which can include computerized prescription orders, test orders, and reporting of test results, along with clinical note-taking systems like Clicktate. Reasons given for their hesitancy in adopting the new technology have included the considerable financial investment required for more comprehensive EMR systems and the lack of overall compatibility across platforms. Less than 30 percent of office-based physicians were using full or partial EMR systems in 2006, according to the National Ambulatory Medical Care Survey of office-based physicians, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. But as the available technology improves, the number of doctors willing to use it is growing, with the percentage of medical practices incorporating full or partial EMR services increasing by 42 percent from 2005 to 2006. Clicktate's founders believe the advantages of its product, namely its ease of use, polished language and affordability, will help it capture a share of this rapidly changing market.
"I think the biggest difference is it was designed by a doctor, and not by IT," said Kowalik, Clicktate's vice president and a native of Poland who has been working in the computer field locally for 10 years. "There are systems that have more functionality as far as covering the whole business of an office, but as far as the note writing itself, there's really nothing as flexible as Clicktate."
Since the launch of the Web site, clicktate.com, in August, traffic has been steadily building to its current level of roughly 3,500 hits per month, and more than 600 physicians, including some from every state, have signed up for the service, Kowalik said.
While physicians as a group generally tend to be resistant to change and there is a learning curve to be overcome for new clients, McKinney said the product has been well-received overall. The company offers all new clients a 30-day free trial, and Clicktate is also providing six months of free access to all health care providers in Lexington and adjoining Central Kentucky counties, as a service to the local health care community. In addition, the company offers its product at no cost to charity and free clinics nationwide.
"We've only had one physician who has stopped using the product," McKinney said, and that decision was fueled by the doctor's move to a new practice with its own established EMR procedures.
Clicktate plans to expand its marketing presence in the near future and is currently investigating possible partnership opportunities with other EMR vendors. The company is also working to develop its own simplified EMR system for smaller practices, which would offer basic functionality at a lower cost than other EMR products currently on the market, McKinney said. Clicktate has been self-financed so far, but as it looks to expand its offerings, it may consider seeking additional investment, Kowalik and McKinney said.
"The bigger it grows, the more challenging it becomes," Kowalik said.
And doctors aren't the only ones who see advantages in more efficient medical note writing systems, McKinney added.
"Nurses who work with doctors love this, because when patients call with questions, they can go back and look at the last note and see what's going on now, instead of trying to decipher somebody's handwriting," McKinney said. That translates to fewer mistakes and more efficiency, McKinney said, and ultimately better care.
"I think it does help them practice better medicine," McKinney said.