Mobile Tech Pays Off for Early Adopters

Bill Briggs, Senior Editor
Health Data Management Magazine, August 2005

Neurosurgeons at Lahey Clinic Medical Center consider themselves conversant with clinical information technology. But it wasn't until the 500-physician multispecialty group practice started using mobile technology that they understood how bringing I.T. to the point of care could increase revenue and efficiency.

Until 2001, Lahey physicians used a face sheet with preprinted procedure and diagnosis codes for each patient encounter, says Peter Dempsey, M.D., a neurosurgeon at the Burlington, Mass.-based practice.

After each patient visit, physicians would check the boxes most closely fitting the level of care delivered. The documentation was imprecise, Dempsey says, because not all diagnosis and procedure codes were on the sheet.

The form then was handed to a staff member who eventually entered the data into a computer. The process usually took days, sometimes weeks, and about 5% of the care delivered was not billed, Dempsey says.

However, after implementing a wireless network and charge capture software, and outfitting neurosurgeons with PDAs, the specialists were able to virtually eliminate missing charges.

"The whole notion of using technology to make us more efficient has become clearer," Dempsey says. "We in neurosurgery were very savvy with clinical I.T., but we weren't so aware of the impact mobile I.T. could have on the revenue side."

Sprinting ahead

Compared with hospitals, group practices typically have brought up the rear when it comes to technology adoption. But mobile technology has enabled some practices to sprint ahead of the pack.

This is due in large part to their decisions to be early adopters of mobile I.T. After the smoke cleared from the Y2K scare, pioneering groups rolled the dice and started using wireless networks and mobile computers to manage unwieldy paper-based patient care and billing processes. Some are now using second-generation applications and even third-generation hardware.

Urology San Antonio, a 21-physician practice with five locations, decided four years ago to implement a wireless network from Cisco Systems Inc., San Jose, Calif., to access an electronic records system from Seattle-based Physician Micro Systems Inc.

Since then it has gone through a few generations of mobile hardware and tinkered with its software. The results? Improved operating efficiency, reduced reliance on telephones and $20,000 per month in transcription expense cuts.

In 2003, physicians used a mix of notebooks running different operating systems-including Windows CE from Redmond, Wash.-based Microsoft Corp.-to access patient data at the practice's offices and a surgery center.

But as the wireless network was upgraded and mobile hardware evolved, physicians decided to change with the times, says Clayton Hudnall, M.D. They gravitated away from computer notebooks running the CE operating system. Instead, they adopted Tablet PCs-from Sunnyvale, Calif.-based Fujitsu PC Corp.-that run Microsoft's Windows XP Tablet operating system, which provides increased support for Windows Office features and applications.

"The notebooks served their purpose and got us introduced to mobile technology, but the screen quality was not good enough," Hudnall says. "And we needed to run other programs, such as Microsoft Outlook as a calendar and communication tool."

The upgraded hardware and software have enabled Urology San Antonio physicians to expand their use of the mobile technology.

Hudnall and his colleagues now can wirelessly access CT scans and show them on-screen to patients in exam rooms. This wasn't feasible with the older generation of technology because of poor screen resolution and slow connections. In addition, the mobile hardware also enhances the privacy and security of patient data, he adds.

"Outfitting exam rooms with PCs and dealing with security issues when there's no employee in the room are big headaches," Hudnall says.

Physicians also collect patient data in real time and pull up graphs of lab work in any of 80 exam rooms across the enterprise. Another benefit of the Tablet PCs is that physicians now can use scheduling functions in the Outlook application to track appointments and other meetings, which has helped streamline their work days, Hudnall adds. "Mobile technology is a more viable financial option than hardwired computers."

Minus the wires

Oswego County (N.Y.) OB/GYN PC had the same goal of getting computers in exam rooms, minus the wires.

In early 2003, the four-physician practice implemented an electronic medical records system-from Greenway Medical Technologies, Carrollton, Ga.-and installed a wireless network from Cisco at its five locations.

The practice initially chose a combination of laptop and Tablet PCs from Fujitsu. Today, most of the physicians use the tablets when seeing patients in exam rooms, says Joseph E. Mather Jr., M.D.

"Having an electronic chart in the exam room has been wonderful," Mather says. "Patients know if I write something my partners can see it instantly. They seem to appreciate the fact it's modern technology and that their chart will follow them."

Oswego County OB/GYN physicians also use PDAs to check drug reference information on software from San Mateo, Calif.-based Epocrates, and to generate new

prescriptions.

Mather and two other physicians use iPAQ hand-held computers from Hewlett-Packard Co., Palo Alto Calif., while Mather's father-also a partner at the practice- has a Treo smart phone from palmOne Inc., Milpitas, Calif.

The drug checking software has proven valuable on several fronts. "I have found four or five patients with meds that shouldn't have been mixed," Mather says. "That's positive for the patient and myself."

On the administrative side, after implementing mobile technology the physicians' billing and coding has been "much more accurate. We were down-coding in the past, but now we're coding more appropriately," he says.

Physicians also access their personal calendars on PDAs and are working on integrating surgery schedules and scheduling meetings on the hand-helds via Microsoft's Outlook.

Built on technology

Hand-held computers have been used at Seattle (Wash.) Eye MDs since its founding in 2000 by Darwin J. Liao, M.D., ophthalmologist.

His two-physician practice tapped into I.T. from the beginning: It implemented an electronic medical records system from IFA Systems AG, Cologne, Germany, and began using hand-helds from palmOne. The practice also uses a practice management application from NextGen Healthcare Information Systems Inc., Horsham, Pa.

"Initially we wanted to integrate data to help us work more efficiently," Liao says. "Now we're looking to use technology more for patient-centric uses." For example, the practice plans to enable patients to electronically self-register for their next visit during check out.

After testing Palm Vs and IIIs, and Tungsten C hand-held devices, Liao and his colleague are using Treo 600 smart phones, in part to access drug reference data from Epocrates and to call up ICD-9 codes for ophthalmology treatments.

Experiments with tablets didn't work out, Liao says. "It didn't make sense in our style of practice, with the amount of time we need to use both hands to operate instrumentation. Something the size of a Palm or Treo is more efficient by far." Liao estimates he invested about $10,000 to implement mobile technology.

Taking measurements

Group practices have different ways of measuring the impact of mobile technology. Seattle Eye MDs registers savings from the combined hand-held and PC-based technology in its staff-to-doctor ratio of 1.5 to 1. "It's usually 3 to 1," Liao says.

At Lahey Clinic, administrative improvements are noted in time lapsed from service delivery until the data is in the billing system, says Dempsey, who also is vice chair of the neurosurgery department. "We've reduced that time from three to five days overall to less than one day," he says. "And we've reduced the time from claim submission to payment collection by 10%."

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