February 1999 Bulletin

SPIN system spares the trees

Digital patient records are sent to insurer, securely, cost-effectively

By Paul C. Collins, MD

There is an old saying around here that whenever someone visits a doctor, a tree dies. What this means is that the paperwork created by seeing a doctor equals at least one large tree's worth of paper. I have no doubt it is the same in your office and getting worse. What with authorization for procedures, visits to wherever and whatever, we orthopedic surgeons are all literally treating the paper as much as the patient. Have you ever tried to guess at the cost to you of this flood of paper? Have you ever wished there was a way out of this?

Enter the computer. In reality, the computer, while speeding things up, has not created a "paperless office", but we have created a way to at least turn the tide a bit. In conjunction with our local programmer, we have developed the SPIN system, an acronym for Secure Patient Information Network. It is a system that can help save the forest from becoming patient charts and records in your basement, storage building or wherever you store them.

The SPIN system was developed because some time ago I sat down and estimated the cost of having someone in our office find a chart, copy it, package it and send it to an insurance company. It was depressing to say the least and take my word for it, don't do the math yourself. That process, however, did lead to a solution and this was the genesis of the SPIN system.

The SPIN system basically involves the provision of your patient records online, using a high level of encryption for security, to provide your patient records at a significantly reduced cost to you and ultimately the insurance companies and others authorized to review the data. Before I get into the details you need to know that I have no financial interest in this system and will not profit if you adopt it for yourself.

It all starts with having your patient records online and in a digital form. If you are still hand writing your chart notes, you can stop here. It is not too important in terms of what format they are in (i.e., Microsoft Word, WordPerfect, etc.) but the key is that they are in digital format. This allows them to be sent online.

Next, you have to set up a system where on a daily, or at least regular basis, these chart notes are sent online to a server system. By this I mean your patient records are transferred to another computer system that is "online" all the time. But what about security you ask. The system is set up to transfer information using the SSL (Secure Sockets Layer) protocol, the same that is used to send credit card information over the web. This is the de facto standard for cryptographic security for the Internet.

By having the information on another computer off-site, your system is not open to "hacking" and corruption. Using SSL protocols also is an insurance for security of the transfers and the data. Also, the transfer is set up on a direct line that does not go through the Internet at all, thus your system is never directly connected to the Internet with this system.

Your patient records are on the remote server and ready to go, but where do they go and who gets them? First, anyone who wants to work with the SPIN system has to have a password to get in. These passwords are unique and generated by a random character generator. At the beginning, the passwords are sent via "snail-mail" to someone requesting one and thus generates a trail of custody, so to speak. These passwords are all time-limited, so if someone passes it around, the use is controlled.

Further, as one passes through the system, there are nodes where they have to affirmatively accept responsibility to protect the confidentiality of the information they acquire at each step.

The program was set up about 18 months ago. We have about 15 insurance companies that have been online with us. If we save 1,000 data collection-distribution events at $20 an event (chart costs, employees, mail etc.) that would amount to $20,000. That doesn't include the e-mail we get from the insurance companies that we answer without creating and sending dictated letters-a large savings that is hard to capture.

What the insurance company does with the information after they have downloaded is their business. The important issue is that they have taken full and documented responsibility for what happens to it when they get it, and this acceptance is automatically recorded and filed.

Paul C. Collins, MD, is chairman of the Academy's Online Oversight panel.

Computer Link welcomes suggestions about future topics for the column and questions about the use of computers in orthopaedic practice. Send your suggestions to the Bulletin at AAOS, 6300 N. River Rd., Rosemont, Ill. 60018.

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