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.
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