Hospitals, med schools inspire physician adoption of handhelds

Hospitals, med schools inspire physician adoption of handhelds

Efficiency and cost concerns push popularity

While handhelds are not yet as commonplace in the hospital as thermometers and blood pressure monitors, they are there, and increasingly in force. Wake Forest University School of Medicine now gives all third-year medical students an IBM WorkPad (IBM’s version of the Palm) as they begin their clinical clerkships, reports Johannes Boehme, associate dean of academic computing. That’s 115 doctors-in-training who will enter their practices using a handheld right from the start.

One way these student docs are using WorkPads is to track the kinds and number of medical procedures, such as caesarean deliveries, they participate in. Such record-keeping is required for their accreditation as physicians. Also on the device is a pharmaceutical reference guide, as well as more common scheduling and address book functions. E-mail functionality will be added during the next year.

Dan Glessner, director of enterprise marketing at Palm, believes that handhelds are so well suited to medical applications that medical training will change to accommodate them. Glessner predicts, for instance, that much of the information students now memorize can be referenced from a handheld.

Cedars-Sinai Medical Center is going heavily toward the Palm, with an estimated 200 physicians carrying wireless Palm VIIs and an additional uncounted number using other Palm models. The use of the Palms, said Dr. Ray Duncan, director of architecture and technology for Cedars-Sinai, has so far been rather ad hoc.

“This was an unfunded project that we originally did for fun,” he said. “The physicians who want to use the wireless apps have to buy the Palm VIIs out of their own budgets.”

Cedars-Sinai physicians use the Palms mainly for remote access to medical records and other data stored at the hospital, and Duncan said the main benefit of the Palm is instant access to clinical information. The hospital is expected to supply Palms to all of its interns and residents next year as part of a formal program.

Wireless LANs are a technology that Caroline Campbell, director of biomedical engineering at Washington Hospital Center, expects to see more widely deployed in hospitals. Driving this is the need for efficiency; doctors can better use their time if they can enter patient records on a laptop or handheld and then send that information to a centralized database via a wireless link.

Ron Kuppersmith, attending physician at Virginia Mason Medical Center, has been beta testing unwiredDr.com from Data Critical. UnwiredDr.com is an Internet platform that lets physicians perform a variety of tasks online using wireless devices. Recently, while in his car, Kuppersmith got a request for a prescription refill. A few quick button commands on his cell phone and the software automatically faxed the prescription to the pharmacy, updated the patient’s record, and notified the patient by e-mail that the refill request had been approved and sent.

The admitting office may undergo even more drastic changes, thanks to wireless technology. Campbell predicts that wireless handhelds will allow the admitting staff to query patients wherever they may be in the hospital, instead of forcing the patient to go to the admitting desk.

“If you have an expectant mother coming in to deliver, why stop her at admitting?” Campbell asked. “Why not bring her directly to the delivery suite and have someone from admitting go to her with a wireless laptop connected to a wireless LAN?”

In the not-too-distant future, it will be possible for doctors to write prescriptions using a PDA and wirelessly transmit it to the pharmacy, where the patient will pick it up. Rob Schwager, president of the healthcare solutions group of Lernout & Hauspie, says that of the three billion prescriptions written each year, 150 million are sufficiently illegible that the pharmacy has to call to find out what the doctor ordered. Wireless technology, along with speech recognition software, should be able to improve the accuracy of pharmacists as they fill prescriptions, while also improving their efficiency.

Schwager also sees cost savings resulting from all the medical reports dictated and transcribed. These number one billion annually, Schwager said, and $10 billion is spent transcribing these physician-generated reports. Using speech recognition and devices such as PDAs, he believes a large chunk of the money spent on transcription can be saved.

Gary Flashner, an emergency-room physician at Hazleton-Saint Joseph Medical Center, has been working with voice recognition and dictation software in the emergency room for several years. Using a wireless microphone, he dictates details about his procedures into a PC; this is then automatically translated into text that can be printed and used in reports. He even relies on macros, which allow him to say, for instance, “Heart OK,” which is translated into, “HEART: regular rate and rhythm, no murmurs.”

Right now, Flashner says medical use of speech recognition software is limited to PCs and laptops because handhelds lack the needed power, but he expects that to change within the next year or two as these devices bulk up their processing power.

More powerful PDAs will certainly spur the use of speech recognition software within the medical community, but what may drive even more notable technological change is a recent ruling from the Federal Communications Commission. According to Dale Woodin, advocacy director at the American Society for Healthcare Engineering (part of the American Hospital Association), wireless telemetry systems have been used for years within hospitals, but their deployment has been limited by the fact that the radio frequencies can interfere with other medical equipment. This can create dangerous, even life-threatening, situations for patients who are dependent on mechanical and electrical devices.

But concerns about patient safety in wireless environments may soon be laid to rest. In July the FCC established a set of frequencies dedicated solely to the medical field. Final comments on the proposed rules were expected by mid-October.

In the long run, improved accuracy and better patient care will make wireless handhelds, speech recognition software, and other devices—especially those that are convenient to use and effective—commonplace in healthcare. But Campbell of Washington Hospital Center says the most important propellant behind this technology’s push into hospitals and doctor’s offices will be money.

“The major driving force is financial,” she said. “We’ve got to become more efficient.”

Reprinted with permission from Planet IT, a CMP Media online resource, and author Alan Horowitz.

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