Dr. Notes Agrees That ``It Is Really About Transforming Healthcare and Fixing This Market''.

DALLAS -- Dr. David Brailer, appointee of President Bush as the National Health Information Technology Coordinator, today said: The Health Information Management System Society annual convention took place last week in Dallas and was attended by more than 20,000 healthcare participants with more than 700 vendors. This week, this is old news. The real news now is how transforming healthcare is going to be accomplished and implemented nationwide. Dr. Brailer further warns, "take steps soon to make it happen or the government will probably impose a solution." If the healthcare industry cannot agree upon such standards by this summer, "then the government will probably do what government does best-put out a mandate." Dr. Brailer further urged the technology executives to set aside their narrow corporate interests, giving up some of their proprietary lock on customers, to open up a larger market opportunity for everyone.

However, Angel M. Garcia, M.D., Founder and CEO of Dr. Notes, Inc., does not see this happening anytime soon. "We are constantly being asked by our customers to link their Dr. Notes Electronic Health Records to their Practice Management Systems and while many vendors are cooperative, there are still large companies who refuse to link their PMS to any Electronic Health Record but their own Level 3. They are trying to force their customers to purchase their own EHR even if they prefer another one."

To make matters more interesting, a study by Blackford Middleton, M.D., M.P.H. was just released last month, entitled "The Value of Healthcare Information Exchange and Interoperability" (HIEI) which may be found on the HIMSS web site online bookstore through this link: http://www.himss.org/asp/book.asp?ContentID=52848 . According to Dr. Middleton and an expert panel that includes Dr. David Brailer himself, there are four levels of healthcare information exchange and interoperability:

Level I: paper records

Level II: machine transportable data: scanned records, faxes, e mails

Level III: machine organizable data: template based

Level IV: machine interpretable data: structured and standardized.

Dr. Middleton further states: "Non-standardized information exchange or Level 3 HIEI is not a good national strategy for either the long term or as an interim step toward standardized Level 4 HIEI. Investments in non-standardized information exchange lock in local solutions, divert resources from developing more universal approaches, delay conversion to national standards and guarantee that additional costs will be incurred down the road to convert to national standards, once they exist."

Dr. Garcia says: "To the best of our knowledge, there are no other Level IV records available in the market today. Only the Dr. Notes Program currently fits the Level IV category as a structured, standardized Physicians Medical Records System."

The difference between a Level 3 HIEI or healthcare data is that it contains formatted data with field definitions down to the field level; however, the actual content of the field remains unregulated. Computers can organize, search, and filter the data but computerized logic cannot be used to fully process the information due to inconsistent content format. It further requires electronic content extraction with human conversion and interpretation of content. Level 4 HIEI or healthcare data, that is machine interpretable data has standardized data exchange without human involvement. Technically speaking the data is encoded using accepted controlled vocabularies; content is not only indexed down to the data point level but also consistently formatted and encoded. Computerized logic can now be applied uniformly to offer full decision support capabilities.

Dr. Garcia further states, "while this may sound very similar, the structured and standardized data collection aspect of the Dr. Notes Programs allows for physicians of the same specialty to collect the clinical data from patients in the same format, whether they are seeing a patient in Miami, or in Seattle." Furthermore, Dr. Garcia says, "another point not mentioned in Dr. Middleton's study is that when data is standardized in such a way that there is common terminology to describe the physiologic or normal findings then the pathologic or abnormal findings are easy to track, thereby making the Electronic Health Record a Clinical Tracking System or Clinical Management Tool."

Dr. Brailer is still studying what is "the right mix of incentives to encourage physicians to embrace digital records such as federally backed loans, grants and extra reimbursement by Medicare and other insurers for using electronic health records." Dr. Garcia states that their physicians have found that eliminating dictation, eliminating $800 to $1,000 per month of transcription costs, saving one to one and a half hours a day as well as increasing the level of the visit by one level has been significant enough for more than 5,000 physicians to purchase the Dr. Notes Program across 47 states. Garcia further states, "there is one more incentive which has yet to be proven, that is the reduction in malpractice premiums." Currently physicians' malpractice premiums are based on the specialty, area of the country where they practice and the number of times they have been sued. With the use of Dr. Notes or a Level 4 Electronic Health Record, medical malpractice premiums will soon be based on how well controlled a physician maintains his patients. For example, a physician who controls 98% of all their Hypertensive patients and 96% of their Diabetic patients may, in the near future, pay much less for malpractice insurance than a physician who only controls 78% of their Hypertensive patients and 65% of their Diabetic patients, Garcia says.

About Dr. Notes, Inc.: A research, design and development software firm based in Boca Raton, FL, Dr. Notes Inc. has been doing business since 1987. The first product available in 1993 was a DOS based Computerized Patient Record System (CPRS) that eliminated dictation and transcription by entering only the abnormal findings, diagnoses and recommendations. The company then converted to Windows in 1996, thereby allowing for the most common abnormal findings to be placed in corresponding pick lists. The Windows based technology allowed physicians to click on the abnormal findings only thereby creating a "documentation by exception" format. Since the standardized terminology separated the normal from the abnormal findings, the Dr. Notes Program became a Clinical Tracking or Clinical Management tool. Now available in 38 medical and surgical specialties, the company re-wrote the program again for a third time in VB.Net with a SQL database in a three-tier environment. This latest technology available only since November 2004, now provides the Dr. Notes Physician Medical Records as an ASP solution on a subscription or transaction fee basis. However, DrNotes.NET can also run on Local Area and Wide Area Networks. In fact, the Company is receiving many Requests for Proposals to provide the technology for Integrated Delivery Networks, Physician Hospital Organizations and other large clients that want to host the application on their own web servers. Dr. Notes, Inc. sells private labels to other vendors and healthcare groups that want to incorporate their Physicians Medical Records technology into other portions of the vast Electronic Healthcare Record.