Overcoming the limitations of proprietary computerized billing systems to enhance patient care.

Most physician offices have proprietary computerized billing systems, but these are not designed for monitoring utilization or addressing patient care issues, and they are difficult or impossible to modify. These systems do, however, contain valuable diagnosis and demographic information. An open-ended, relational x-base system is described that downloads this billing information and combines it with additional input to provide the practitioner with: current problem lists; medication and allergy lists; health screening reminders that are age, sex and disease specific; and commonly used demographic information. Several popular query/reporting tools are used to generate standard reports and ad hoc inquiries that relate directly to patient care. Two studies, one involving alerting physicians to possible adverse medication effects on specific patients, and one investigating appropriate use and billing of stool occult blood testing are summarized. In the constantly evolving arenas of utilization, outcomes research and cost efficiency, such an open ended, time efficient system has unlimited potential to improve patient care.