Automation in the Doctor's Office PDF

1 4:1 6 Automation in the Doctor's Office Once it was considered a good joke to ask a doctor when illnesses would be diagnosed by computers, but now the joke has become reality. Computers are indeed making speedy diagnoses. Pertinent data are fed into the...

1 4:1 6 Automation in the Doctor's Office Once it was considered a good joke to ask a doctor when illnesses would be diagnosed by computers, but now the joke has become reality. Computers are indeed making speedy diagnoses. Pertinent data are fed into the machine and in a matter of minutes the machine feeds back a diagnosis, or perhaps several possible diagnoses. Electronic devices are also used to speed up clinical pro- cedures and obtain more accurate results from them. This kind of automation, however, does not concern the medical secretary so much as do the business machines that expedite and lighten her own work. DICTATION AND TRANSCRIPTION MACHINES Equipment for dictation and transcription is used by many doctors today. Such devices make it possible for the doctor to dictate letters, reports, or articles while his secretary is busy elsewhere. The dictation unit may be on the doctor's desk, in his home, in his car or, if powered by batteries, even around his neck so that he can dictate his findings while examining a patient. The recording device may be a plastic disc, a wax-coated or plastic belt, magnetic tape, or wire. Machines come in various sizes: miniature, portable, and standard. They will record from 90 minutes to several hours of dictation, according to their size. All of these have a switch that allows the dictator to play back the record and to make corrections.  Some machines are used both for recording and transcribing; in others there is a separate part for each of these functions. Instruction booklets accompany each instrument to explain how to place the recorded material on the machine, whether disc, belt, or tape, and how to operate it. One can learn to operate the machine in a few minutes, but a certain amount of practice is necessary before transcriber becomes sufficiently accustomed to the procedure to use it smoothly.. The principles of transcription are the same regardless of the type of machine and recording device used. The machine is placed next to the type- writer, plugged in, and started. It may be equipped either with a headpiece When transcribing from a machine, listen carefully for instructions and corrections. Usually a good dictator begins by stating how the material is to be set up and how many copies to make. 120 isin ihm baeculury int Scanned with CS CamScannerTM (earphones) or an amplifier. Tone, volume, and rate of speed can be regulated to the secretary's own comfortable reception and rate of typing. A foot-pedal switch is useful, both for starting the machine and for reversing it. Another helpful item is an index counter, which makes it possible to locate a specific reference speedily and to indicate the length of a letter. It is most important that the secretary listen carefully for instructions and corrections. A good dictator will start out by telling the typist how many copies to make, whether he has any preference about the set-up of the material, paragraphing, and other matters. Corrections may occur at any place. If the secretary is interrupted, the machine can be turned back to find the correct place for beginning again. The device that makes this possible is also useful in another way: if the secretary has not understood the dictation, she can replay it at any point. The secretary's skill at spelling, her knowledge of punctuation and capi- talization, and her familiarity with medical terminology will determine her efficiency in transcribing the doctor's dictation. By the use of a simple device on the machine, dictation can be erased from tape, wire, and wax records, and the recording material can be used over and over again. Discs and belts cannot be reused, but it is often advisable to file them for later reference. DUPLICATING METHODS In every office it is sometimes necessary to make copies of certain papers- a letter, a bill, a report, a memorandum, a patient's history. If the document is one that is being typed in the office, as many as 8 to 10 clear carbon copies. can be made at one typing by using onionskin copy paper and featherweight carbon. If more copies are needed, say 50 or 100, a special duplicating process must be used. Stencil Duplicator This is one of the least expensive methods of duplicating. The material is typed on a wax-coated stencil. A lever on the typewriter disengages the type- writer ribbon, so that the type cuts the characters directly onto the stencil. It is advisable to proofread the stencil as it is typed, preferably every one-half dozen lines. Use a correction fluid on the stencil for errors. Let it dry for about 30 seconds and then type the correction, using a somewhat lighter touch. If artwork is to be added, the stencil is placed on an illuminated drawing board. With special styli and lettering guides, various patterns and styles of letters may be drawn on the stencil. The stencil, when finished, is mounted on the drum of the duplicating or mimeographing machine, on which the ink pad rests. The ink is forced through the cuts in the stencil as it passes over the duplicating paper, which is fed into  122 MEDICAL SECRETARIAL PROCEDURES Scanned with CS CamScannerTM the machine by rotary motion. Black ink and heavy white paper give the best results. The supply of ink must be kept at a consistent level, or the copies at the end of the run will be dim. The newer machines will make about 200 copies with one inking. Small mimeographs are hand-operated, larger ones are automatic. The various machines differ somewhat in their operation, but the prin- ciple is the same. Follow the instructions supplied with each model. Stencils are available at most stationery stores and can also be ordered from the manu- facturer of the machine. Chemical Duplicators This is another inexpensive duplicating method. The text is typed on a "master" which rests against a special carbon, so that the typed material appears in reverse on the back of the master. The master is attached directly to the rotary drum of the machine, and as the copy paper is fed into the duplicator, it is moistened with a special duplicating fluid. The master prints the text in purple ink. Artwork can be drawn on the master with a hard pencil or a ball- point pen. Errors are corrected by erasures with a block-out pencil. Then a small piece of fresh carbon paper is put over the erasure and the correction is typed. Stencils and masters kept for later use should be protected with a sheet of tissue paper. A chemical duplicator is illustrated on page 124. t method is advantageous because it works at high speed, requires no fluid, and can make copies from any kind of paper. However, it will copy only inks with a metallic or carbon base. The finished product does not look as well as those of other processes. The special paper needed is rather  costly. The dry-heat copier is shown on page 125. Diazo. In this process the paper to be copied is brought into contact with paper that is coatCopying Machines The simplest, neatest, and quickest way of making copies is by one of the newer, processes that require no stencil or master. The paper to be copied is inserted into the machine and a copy is produced in a matter of seconds. These machines operate on several different principles. Dry Heat. A specially coated paper is placed on top of the document to be copied. Infrared rays shoot through this heat-sensitive copying paper and the printed or typed material is transmitted instantaneously. The dry-heaed with diazoniurn salts. The machine sends ultraviolet rays through the material to be copied and the chemicals react to form a dye and thus reproduce the original. This process makes excellent copies when special translucent forms are used. Although the machine itself is relatively expensive, it is the least costly to operate. It is recommended especially for reproducing ledger cards for billing. AUTOMATION IN THE DOCTOR'S OFFICE 123 Scanned with CS CamScannerTM Detti inc.. CHEMICAL DUPLICATOR In chemical duplicating, copies are produced from a "master" which is typed and attached to the  machine's rotary drum. Dye Transfer. This is a variation of the photocopy process. The material to be copied is placed' face to face with the matrix and exposed to light. The matrix is then developed and forms the negative. The negative is pressed against the copy paper, on which an exact image appears. Five to six extra copies can be made at very little additional cost by pulling additional sheets of plain paper through rubber rollers together with the existing negative. Diffusion Transfer. This process also requires two nun-throughs. The first run makes a negative, the second puts the negative into a solution and makes the reproduction. This machine requires the smallest initial investment and will make excellent copies regardless of the quality of ink or paper used. Photocopy Devices. The material to be reproduced is placed in contact with a sensitized sheet and both are exposed to light. Black and white positives result. Xerography. This process involves photography and electrical charges. It is rather complicated and is particularly suitable for reproduction of photographs and art work. Because most copying machines require special paper, the cost of making copies may be a considerable item. It varies from 2 to 9 cents a copy, depend- ing on the method used and on the number of copies made. However, the time saved is so considerable that every doctor should seriously consider the purchase of a copying machine. As this is a comparatively new field, improvements and more efficient methods are constantly being introduced. If the doctor is con- templating the acquisition of a copying machine, a survey should be made to ascertain the latest developments. Points to be taken into consideration are (1) initial cost, (2) ease and speed of operation, (3) number of copies that can be made, (4) appearance of final product, and (5) cost of copy paper. If the secretary finds a machine in the office, she should study the instruc- tion book carefully, even though the operation is usually quite simple. 124 MEDICAL SECRETARIAL PROCEDURES Scanned with CS CamScannerTM DRY-HEAT COPIER Infrared rays reproduce typed or printed material on heat. sensitive copying paper almost at once in the dry-heat copier. Thermo-Fax from Minnesota Mining and Manufacturing Company MISCELLANEOUS OFFICE MACHINES Industrial concerns, hospitals, and institutions of all kinds use a great number of business. machines to carry on their many activities with greater speed and accuracy. Some training is required to operate them, and a secretary who must use such machines would have to be instructed accordingly. Only a few simple machines are needed in a doctor's office, and these are discussed here. Adding Machine This is an extremely useful tool for the medical secretary. Many book- keeping and recordkeeping duties that she performs require the accurate addi- tion of figures. For example, the entries in the day book must be totaled each day, the amounts of the checks received must be totaled and compared with the deposit slip, the patients' ledger accounts must be checked for accuracy, and the debit and credit balances of the general ledger accounts must be totaled and compared periodically. (See Chapter 8 for details of these procedures.)  The machine of choice is a 10-key adding machine, which is shown on page 127. It is adequate for most doctors' offices. The machine may be hand- operated or electric. In the hand-operated machine a lever is pulled down after the keys for each sum have been pressed; in the electric machine a bar is pressed down. A roll of paper tape is attached to the back of the machine; when the lever is pulled down or the bar is depressed, the number is printed on the tape. Thus a complete record is made of each operation. The 10-key machine is operated by one hand with the touch system. In this way. the operator need not look up from her worksheet. Practice will soon develop skill and speed equal to that of typing. To operate, the fingers of the right hand are placed so that the index finger rests on 4, the middle finger on 5, and the fourth finger on 6. Each finger controls the key above and below these (7 and 1; 8 and 2; 9 and 3). The thumb rests on 0, and the little finger is used to strike the bar that prints and adds the figures that have been pressed down. AUTOMATION IN THE DOCTOR'S OFFICE 125 Scanned with CS CamScannerTM In xerography, the combination of light and static electricity reproduces both line art and typed or printed text on untreated paper without chemical aid. Xerox Corporation The machine must be cleared before each operation. This is done by pressing the total key. Some symbol, usually an asterisk (*) will appear to show that the registry. has been cleared. To add, press down the keys for each set of digits, one key at a time, then strike the plus bar, repeating this process to the end of the column. When the entire column has been copied, the total key is pressed down, and the grand total appears on the tape. Tear off the tape; it is your computation record. To correct an error before the plus bar has been struck, use the correction key to clear the incorrect figures from the machine, then strike the correct figures. If the error is discovered after the plus bar has been struck, either sub- tract the wrong figure and add the difference between the correct figure and the error, or total the column, clear the machine, and start again. For adding dollars and cents, a special decimal point key is used which automatically prints the figures with a point between dollars and cents.  If a subtotal is needed, add columns as indicated, depress the subtotal key at the desired item, and continue adding. For subtraction, print the amount from which a subtraction is to be made, then the amount to be subtracted, and strike first the minus bar, then the total bar. The correct solution will appear on the tape. 126 MEDICAL SECRETARIAL PROCEDURES Scanned with CS CamScannerTM The 10-digit machine also handles multiplication, by a process that is basically the same as the one used with pencil and paper, but it is done much more quickly on the machine. Let us say that the multiplicand (the number to be multiplied) is 65, and the multiplier (the number by which 65 is to be mul- tiplied) is 43. Figuring with pencil and paper, the total is 2,795. This figure can be reached much more quickly by using the adding machine, and here is what to do: first, clear the keyboard by pressing the "total" key. Then enter 65 on the keyboard. Next, press down the "multiply" key until 65 is printed and added 3 times, 3 being the first unit of the multiplier. Then enter a zero on the key- board to change 65 to 650. Press the "multiply" key four times, 4 being the second unit of the multiplier. The next step is to clear the keyboard by pressing the "correction" key. Then depress the "total" key and the correct answer is 2,795. The tape will show these figures:.00T 65 65 65 650 650 630 650 2,795 Grand total Folding Machines When many pieces of mail must be folded and inserted into envelopes, these machines are used. They can be adjusted to fold paper to the size of the envelope. The operator feeds the material into the machine, which automati- cally folds, inserts, and stacks it. (There is another machine for sealing and stamping.) The 10-key adding machine is adequate for most doctors' offices. The machine is oper- ated by one hand with the touch system. AUTOMATION IN THE DOCTOR'S OFFICE Remington Office Machines 127  Scanned with CS CamScannerTM Collators When several sheets of paper are to be stapled together, (a bulletin for instance), a collating machine will pick up the individual sheets in the desired order. Some of the more elaborate collators will also staple the sheets. Addressing Machines If frequent mailings are sent to the same persons, means must be found for reproducing the addresses quickly. In a manual operation, labels are typed with two copies, so that three labels are available (more than two copies are rarely satisfactory) for successive mailings. With machines it is possible to type the address on a stencil which may be hand-stamped on the envelope. More elaborate machines use a permanent stencil, cut either in heavy cardboard or in metal. Stencils are fed into the machine automatically at the same time as the envelopes. By pressing down the stencil, the address is transferred to the envelope. The foregoing discussion deals with those mechanical devices most often found in a medical office. In addition, the secretary should be aware of the many mechanized services available commercially, such as the billing service (men- tioned earlier), automatic letter writing, mailing, multigraphing, and copying. The classified telephone directory should be consulted for any such services. Many companies have their own computers and can offer service in statistical research, accounting, and many other areas, If the secretary is required to punch the computer cards, special training will be necessary. BUILDING A MEDICAL VOCABULARY  Word ending: -oma a swelling; usually a tumor, either benign or malignant Term adenoma tumor of glandular tissue carcinoma malignant new growth 1 fibroma Definition glaucoma tumor of fibrous tissue hardening of eyeball (erroneously considered a tumor by ancient phy- sicians) tumor consisting of glia cells (connective tissue of nervous system) tumor containing blood glioma hematoma hepatoma tumor consisting of liver tissue lymphoma tumor originating in lymphoid tissue myeloma tumor in bone marrow myoma tumor of muscle tissue papilloma epithelial tumor (for example, warts) sarcoma 128 malignant tumor of tissues other than glandular MEDICAL SECRETARIAL PROCEDURES Scanned with CS CamScannerTM