Mobile Tech a Hit with Groups

Bill Briggs, Senior Editor
Health Data Management Magazine, October 2004

Richard Katon, M.D., wasn't completely sold on the idea of using a PDA to generate electronic prescriptions until he left it at home one day. As Joni Mitchell once sang, he didn't know what he had until it was gone.

Less than a month into using the hand-held computer, he was surprised how much he already relied on it. "I was shocked when I forgot my PDA-and missed it," says Katon, a family practitioner at Family Healthcare, a seven-physician practice with three offices, headquartered in Germantown, Md. "I couldn't believe it, after only three weeks."

The hand-held computer's functions had overcome Katon's fears, and in a hurry. "I'm not a real typist, and I was very hesitant about whether I could use it effectively," he explains. "But it's very handy and quick."

Family Healthcare represents the growing ranks of group practice-based doctors and nurses that depend on mobile technology to improve patient care and streamline their practice of medicine. Caregivers are using tools including PDAs, laptops, Tablet PCs and smart phones to access patient data and medical reference information, and capture charges.

Many of these practices perform data entry and access data via wireless local area networks using Wi-Fi technology or by periodically synching PDAs and smart phones to download data by infrared signal.

As implementations increase and success stories spread by word of mouth, group practice physicians' awareness of mobile technology grows. In fact, it's getting difficult to avoid the technology.

For example, group practice-based doctors are increasingly likely to encounter wireless local area networks in hospitals with which they are affiliated. Also, in Health Data Management magazine's 2004 CIO Survey, respondents said Tablet PCs and PDAs were the mobile hardware most likely to have the greatest impact on health care.

The 25-question survey was e-mailed in February to a sample of HDM subscribers who work at hospitals, integrated delivery systems or group practices, and whose titles reflected I.T., medical records or group practice administration responsibilities.

Wireless by 2005

Almost 46% of 501 respondents agreed or strongly agreed that a majority of their organization's doctors will be wirelessly accessing networks and the Internet before the end of 2005. Many already are on their way.

Some physicians begin exploring mobile technology on their own initiative, using PDAs much like a paper-based daily planner. The hand-held computers initially help manage personal schedules and store often-called telephone numbers.

That typically leads to more direct patient care uses as doctors apply hand-held technology, including PDAs and smart phones, to store and access drug and other medical reference information. As physicians in group practices find more practical uses for mobile technology, visions of even broader usage are taking shape. In addition to pursuing wireless LANs in their practices, some doctors have even installed such networks in their homes.

Nurses might have less exposure to mobile technology in their personal lives, but they often are quick to see the value of accessing data where they are, rather than where workstations are located. While most group practices have their information technology champions and "super users," successful implementation and use of mobile technology often depends on how the rank-and-file caregivers adapt.

Like Katon at Family Healthcare, some physicians' initial expectations of mobile technology's benefits were countered by apprehension of the cost. "I thought it would be effective for minimizing errors, but I also thought it would slow us down a lot," he explains. Since mid-May, when the practice's doctors began using mobile software from New York-based HealthRamp Inc., that hasn't been the case.

The practice uses the HealthRamp system-on PDAs from palmOne Inc., Milpitas, Calif.-to wirelessly transmit prescriptions to a host computer. Prescriptions then are electronically faxed to a patient's pharmacy of choice.

"We don't lose any time using the technology," he says. "And it's such a benefit to patients."

In the "old days" of prescription writing, the patient carted the paper script to a pharmacy. Then the patient waited there for the prescription to be filled, or left and returned later. Either way, he says, patients spent too much time waiting.

Patients enthralled

Now, while he and his physician colleagues are talking with a patient and pondering their specific problem, that process is chopped down to size. "I open the PDA and the patient's name comes up on the day's schedule. Within seconds I can transmit the prescription to the pharmacy and it's waiting for them when they arrive," Katon explains. "Patients' mouths hang open in awe."

Katon can write and transmit prescriptions from a PC or his hand-held computer. He also can send prescriptions from his home on the hand-held by logging into his wireless network from Irvine, Calif.-based Linksys, a division of Cisco Systems Inc. Such capabilities have helped Katon and his colleagues warm to mobile computing.

Prescriptions also figured into Ronald Uva's early use of mobile technology. After buying his first PDA in 1998, he downloaded a free copy of drug reference software from ePocrates Inc., San Mateo, Calif.

Uva checks drug dosages and indications using an iPAQ hand-held computer from Hewlett-Packard Co., Palo Alto, Calif. But since he bought the most recent version of the reference software, he's been able to factor in alternative treatments. "The software lists alternative medicines," explains Uva, an M.D. and president of the five-physician Oswego (N.Y.) County OB/GYN. That helps manage another layer of medications, because "people are using all these herbals, but we can't keep them all in our heads."

Oswego County OB/GYN implemented an electronic medical records system and a wireless LAN from Greenway Medical Technologies, Carrollton, Texas, in March 2003. The practice also purchased Tablet PCs and laptops from Dell Computer Corp., Round Rock, Texas, which physicians and nurses use.

Uva uses a pen-based Tablet PC when examining obstetrics patients to record fetal heart rate, whether the patient is having contractions, fetal movement and position of the baby. The system also enables doctors to review all lab work "just by tapping the screen," he says.

That's an improvement over the previous method, which required physicians to thumb through paper records and notes in each patient's chart at each prenatal visit. And the Tablet PCs can move among exam rooms because they send and receive data wirelessly.

`Computer-OK'

Like many other physicians, Uva's medical education came before the advent of information technology. Curiosity drove him to learn about accessing drug information on a PDA, but he wasn't necessarily a proponent of mobile technology. "I'm 55 years old," he notes. "I was `computer-OK,' not computer-savvy."

Uva attended a conference in 2003 in which a physician described using a PDA for all of his mobile computing needs. But Oswego County OB/GYN was rolling out its new hardware at the time and Uva felt the laptops and Tablet PCs would be the hardware of choice.

With those devices linked to the practice's electronic records system, mobile access to data has become an important part of patient care. The combined technologies have made doctors and nurses more efficient, and documentation is "100% better," he adds.

Documentation of a different sort led Judith Odenheimer, M.D., and Dedham (Mass.) Medical Associates to mobile technology to help capture patient charges. Odenheimer, a pediatrician at this 60-physician multi-specialty practice with two locations, is using an iPAQ PDA to log charge information into coding software from MedAptus Inc., Boston.

The practice rolled out the charge capture system about two years ago, Odenheimer says, starting with pediatrics. She enters charges on her PDA and transmits the data over a wireless LAN to the organization's billing office. Another company acquired the wireless network vendor and Dedham Medical Associates is exploring new options for supporting its LAN.

Fast curve

The PDA-based method was "easy," once doctors were through the learning curve. "At first it's awkward," Odenheimer says. "You can't find procedure or diagnosis codes, and it takes a lot longer. But then you realize the curve goes fast." Clinicians were proficient in about two weeks.

Once doctors became adept at using the mobile technology, benefits surfaced, including prompts to help decide the level of treatment for a given diagnosis. Staff pediatricians developed templates for the most common diagnoses, which improved charge filing speed as well as accuracy. "Even the less common codes are easier to find online than on paper," Odenheimer adds.

Computer aptitude can play a part in clinicians' general resistance to changing medical processes. Some fear losing their autonomy if they rely too heavily on technology.

But learning to use hand-held computers to document charges has helped improve Dedham Medical Associates caregivers' outlook on mobile technology. Any fears of losing autonomy are less a concern than making mistakes. "The potential for error in free-form work is high. It's not intentional; it's well-meaning people doing the best they can. But when technology can enable processes it's only going to help."

Using a smart phone has helped Willy Chu, M.D., save time when accessing patient lab reports before surgery. Chu is a neurosurgeon with First Health of the Carolinas, a three-hospital delivery system in Pinehurst, N.C., and is one member of a three-surgeon office in Pinehurst.

Chu accesses patient lab data through an application from MercuryMD Inc., Durham, N.C., on his Handspring Treo 600 smart phone from palmOne.

"This saves a tremendous amount of time looking up patient labs in the morning," Chu says. "Before, I had to sit down in front of a computer and call up each patient's record. This is much quicker."

Chu downloads patient data by synching his smart phone with one of Pinehurst-based Moore County Regional Hospital's infrared data ports. The hospital has a Wi-Fi network, he says, but his smart phone has no wireless card to enable access to the network. He estimates about 40% of his physician colleagues are using PDAs to access patient data in the MercuryMD application.

Chu has been using his smart phone to access patient lab data since early this year. He's not a stranger to smart phones, having purchased a first-generation model when they came out. The new one has more functions and improved screen size.

Chu pursued the smart phone technology on his own because he saw its potential for improving his access to patient data.

Once group practice clinicians get a taste for mobile technology, they begin to see further uses ahead.

For example, Chu hopes smart phone technology one day will enable him to access the Internet to review medical reference material. The phone's processors are too slow for practical Internet access now, he contends.

Chu also would like to see other devices consolidated into the smart phone. "It would help if they could combine a pager, cell phone and PDA."

Ahead of such multiple uses, however, Chu would like to write test orders and prescriptions from a PDA or smart phone. "It would be great if I could send a prescription from my phone to a pharmacy," he says. "It's not on our drawing board, but it's great conceptually."

Mobile prescription writing capability figures into other physicians' technology wish lists. "I would love to use mobile technology for prescribing," says Odenheimer of Dedham Medical Associates. "We're supposed to get it, but we're not there yet."