Original PC developer doesn't hold much stock in paperless practice: Electrical engineer-turned-doctor says today's software is not yet physician-friendly. (Medical Records).

YOU'D THINK ED Roberts' medical office would be filled with computers, the latest medical software, digital assistants and other hightech gadgets. After all, nearly 30 years ago, Roberts -- an electrical engineer turned medical doctor -- helped develop one of the world's first personal computers.

But that's not the case. The truth is Roberts spends very little time working with computers. That's because time is precious for this doctor who says he's too busy to devote much time to computers.

And he says he's not convinced that existing software with its awkward, often irrelevant, features will make his practice operate more efficiently.

"One of the mistakes being made right now is that software is being written with the idea that everything has to be on the computer." Roberts says. "You don't work that way, you are not taught to think that way and it is a cumbersome way to go."

Such comments may be common for physicians reluctant to dive into the digital age. But for a man whose expertise spans the sciences of both electronics and medicine, it comes as a surprise.

The road Roberts traveled

Today, Roberts, 59, is an internist serving Cochrane, Ga., a tiny town about 100 miles southeast of Atlanta. That's a long way from where he was in the late 1960s and early 1970s working as an electrical engineer in Albuquerque, N.M.

Assigned to a weapons lab with the U.S. Air Force after he graduated college, Roberts was in Albuquerque when he formed his first company, Micro Instrumentation Telementry Systems (MITS).

"We built telemetry equipment for rockets. That was in 1968 and 1969. We didn't do too well because there was not much demand for our product, but we learned a lot about setting up a company and marketing," Roberts recalls.

"By that time, the large scale and medium scale integrated circuits were becoming available. And I became intrigued about building a calculator. But my partners said there was no market for home calculators, so we parted company and I bought them out. Before I got into the calculator business, large-scale integrated circuits became available. And I built the first large-scale calculator for the market."

Known as the MH 16 Calculator, it wasn't anything like the slim, pocket-sized calculators available today. It was about as big as a sheet of paper and sold as a kit for about $170.

From the calculator, sprang the idea for creating a home computer. So Roberts and his company developed the Altair 8800, a breadbox-sized contraption that also sold in a kit and was one of the first computers designed for personal use.

An article on the Altair 8800 appeared in Popular Electronics magazine in January 1975.

"Project Breakthrough!" read the magazine cover's bold red headline. "World's First Minicomputer Kit to Rival Commercial Models ... 'Altair 8800"'

The response was overwhelming. Computer buffs began calling MITS to find out more about the computer and how it worked. One call came from two Harvard undergraduates who saw the article and got excited: Bill Gates and Paul Allen.

"We were getting ten calls a day from other software people, as well. It became difficult to distinguish. who was real and who wasn't," Roberts recalls. At the time, the company was searching for programs and software to run on the Altair 8800

"I made the decision that the software had to be in BASIC programming language. And the first person to show up in Albuquerque with a workable BASIC program would have the contract," Roberts says. "There were probably thirty or forty people who were candidates. Paul Allen called and said he had a system he wanted to demo. That was the spring of 1975."

Bill Gates goes to Albuquerque

Allen quickly arrived in New Mexico, ready to show off his BASIC software to Roberts and the MITS staff.

"I picked him up at the airport. He was maybe 21. I took him to the hotel in Albuquerque, and he said he didn't have any money to pay the hotel bill so I gave him my credit card so he could stay in the hotel that night," Roberts says.

"The next day, we loaded up his software, but then it crashed. Paul knew what the problem was, so he called Bill (Gates) and they cut a new tape. They sent it out airfreight, and we loaded it and it played. It had a lot of bugs in it, but for a brand new piece of software that had been developed without ever seeing the Altair, it worked, and I was impressed.

"What those guys had done, instead of the usual approach, which was brute force design of software, they had taken the time to design an emulator.

...They had the power to simulate the Altair system. That's the standard way things are done now, but it was unprecedented then, and that was the genius of what they did."

Roberts liked what he saw with Allen and Gates, so they set up shop at MITS and wrote the BASIC programming for the Altair.

What's Roberts' view of Gates, the multi-billionaire who heads Microsoft today?

"Bill is an extremely bright guy, but as far as his technical ability, he isn't unique and that is not why he is where he is," Roberts says. "He has enormous business skills. He has a genius for business, and he would not like to admit this, but luck was a big part of his great success."

Several models of Altair computers were produced and sold over the next few years. And, according to Microsoft, Altair was the first computer to run Microsoft software.

In 1977, Roberts' marketing director, Dave Bunneil, had a brainchild to stage the First World Altair Computer Conference to draw more attention to the computer. "I thought it was a bad idea because I didn't think anybody would come to Albuquerque," Roberts says. "But I was wrong. Thousands of people showed up.

That same year, with MITS steeped in tricky contract disputes, Roberts decided to sell the company. He owned one-third of the stock and sold the firm for $6 million.

The move into medicine

In a startling career change, Roberts left New Mexico and moved to rural Georgia where he bought a 1,000-acre farm and began raising cattle and crops. But after a few years, farming proved unsatisfying for a man used to scientific challenges.

So Roberts applied to medical school.

The move toward medicine wasn't that unexpected. Roberts says he seriously considered a medical career when he was an undergraduate. But electrical engineering won out.

Roberts was 39 when he was accepted at Mercer Medical School in Macon, Ga., where he graduated in 1986. Following post-graduate training in internal medicine, he opened a solo practice in Cochrane, Ga., in 1989.

"I did internal medicine for two-and-a-half years at the Macon Medical Center. I was working the emergency rooms at night, and one of the emergency rooms I worked in was in Cochrane," Roberts explains.

"Then, one of the doctors in Cochrane died, and other one said he was going to retire, which left the town without a doctor. The town had a hospital, and the catchment area for the hospital was about 20,000 people. I left residency to start a practice because the town had no doctor."

On a typical day, Roberts sees 30 to 35 patients. That leaves little time for computing.

"Until a few years ago, I was still doing design work on electro-cardiography and process control," he says. "But I have gotten so busy, I just don't have time to do much computer work."

Roberts says computers are important for small practices when it comes to some tasks, but he doesn't think technology is advanced enough to support a truly paperless office.

"The way things are going now, if you're going to meet the compliance standards for (evaluation and management) guidelines for Medicare, you're going to have to use the computer. In terms of control, with so many new drugs coming out, you're going to have to have a computer to track drug usage and interactions," Roberts says.

"If you try to sit down and figure out what you should charge the government without 'defrauding' them, to use their term, you quickly realize meeting HCFA guidelines is a hopeless, idiotic mishmash. But since we went to the computer, we can document what we do and we are running at least one level of coding higher than what we did before."

"If the computer stuff is done right, it should be pretty intuitive. I wrote a program for doing patient contact. Such a program has to be intuitive, and it has got to work the same way you work. And it has to be a paper-based program."

Roberts says computer programs today do a great job of collecting data and printing out information in hard copy.

"But don't try to force a doctor to switch over to a paperless system. It isn't going to work. That's why the computer hasn't been accepted by doctors. You have to bring a computer into the practice where it doesn't disrupt what you're doing."

For the last three years, Roberts' office has used a computer program that Roberts wrote that meets all requirements of the Clinical Laboratory Information Act.

"I would be crippled without it. We tried to market it, but marketing it was not high on list of priorities, so that effort hasn't gone anywhere. We print the data on narrow strips and tape it in the chart," he says.

"Our program allows us to document all the positives and negatives without writing it out by hand. All I have to do is hit the button on the computer," Roberts says.

"If you write everything out by hand for a level 4 visit, it is a hellish task and you're wasting a lot of time. And when you have patients hanging off the chandeliers in the waiting room, you don't have time to write things down."

Richard L. Reece, MD, is a health care writer, editor-in-chief of Physician

Practice Options, a health care futurist and an organizer of Internetbased physician conferences.

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Ed Roberts, MD, helped invent one of the first home computers and once worked closely with two fledgling corn puter junkies: Bill Gates and Paul Allen. But three decades later, the former electrical engineer says computers can help a small medical practice be more efficient, but they aren't advanced enough to handle every task.