Handhelds serve healthcare providers across the industry

July 1, 2005

There are more applications for handheld devices than just formulary compliance

Handheld or PDA technology is being used in a wide range of healthcare settings across the United States. Healthcare organizations are benefiting from PDAs-from medical schools and university health centers to private hospitals and even the government and military.

The Ohio State University Medical Center, located in Columbus, prides itself on its commitment to patient care, teaching and research. In conjunction with the College of Medicine, the center initially purchased and deployed 1,000 Palm m505 handhelds and 600 m515 handhelds to medical students, attending physicians and residents, allowing them to retrieve patient information and results through eRounds software from Siemens Medical Solutions. The Medical Center and its partners have distributed over 3,200 PDAs in the last three years with about 2,200 plus in operation. Most of them are Palm handhelds.

"Residents arrive in the morning, take their Palms to the nurses station and use the infrared port to sync. The syncing process starts immediately, giving them their patient list and their patients’ medical history for the past 48 hours. The medical students and residents have the most up-to-date patient information with them wherever they go. Just providing the handheld devices to medical students has increased their loyalty to our institution. The medical students appreciate that they’re exposed to the latest technology while they’re studying here," says Robert R. McKenney, director, information systems, student educational services and, and adjunct instructor, biomedical informatics.

The OSU Medical Center provides care to approximately 33,000 inpatients and 625,000 outpatients every year, operating autonomously from the Ohio State University. With four hospitals and 50 outreach sites, the medical center employs 800 attending physicians and over 500 residents. Over 800 medical students receive their training at the OSU Medical Center facilities and the center.

To ensure that the information on the devices would always be current, the medical center relied on XcelleNet’s mobile infrastructure solution, which provides device management features that allow the IT department to know who has which device, which software is licensed to each device, and how much memory is remaining. Users simply stop by any one of 50 nurses’ station or the student lounges in order synchronize their handhelds using Clarinet Systems' EthIR STAR devices. Within a minute or two the infrared technology completely updates the user’s handheld. The XcelleNet synchronization process even pushes software updates onto the devices, recognizing different user profiles and tailoring updates to each specific user group.

Student Achievement

Harvard Medical School (HMS) is one of the world's most prestigious medical institutions and has the largest medical school faculty in the world, with about 9,000 physicians involved in teaching, research, or patient care responsibilities. In addition to their medical training, HMS students are expected to be up-to-date on technology as it relates to medicine and healthcare delivery, and also capable of using the technology. Increasingly, physicians are turning to handheld devices for common clinical tasks such as dictating patient notes, writing prescriptions, and most commonly, accessing a range of clinical references that until recently were only available in a hard copy format.

As such, all incoming HMS students are required to have a handheld device, and students are oriented in the use of handheld devices when they arrive, and by supporting selected applications for the students’ devices, HMS ensures a common, high quality set of knowledge resources for its students.

In particular, HMS faculty sought a powerful but easy-to-use solution that could assist students, and doctors, with knowing what medicines would be appropriate to prescribe and selected the Epocrates Rx Pro drug reference application. The Epocrates reference information is consulted by tutors and students at patients’ bedsides and in classroom settings, in discussions about dosing, drug interactions and patient safety.

“In my role as CIO at Harvard Medical School and as Associate Dean for Educational Technology, I oversee all student and faculty IT initiatives. Epocrates continues to be our most popular mobile application. Our students in the clinical years rely on Epocrates every day to write accurate medication doses for their patients,” says John Halamka, MD, chief information officer, Harvard Medical School and CareGroup.

The software is deployed to more than 1,000 handhelds. With students training at 72 different sites. According to Dr. Halamka, PDA technology in general has improved the school’s overall business efficiency, resulting in about $150,000 annual in savings through the elimination of paper for announcements and surveys.

A 2002 JAMIA study conducted by Jeffrey Rothschild, M.D., MPH and David Bates, M.D. at Brigham and Women's Hospital in Boston, showed that physicians using Epocrates drug references can improve patient care by avoiding adverse drug events while increasing practice efficiency and patient satisfaction.

Hospital Application

Central DuPage Hospital (CDH) in Chicago is a large, independent community hospital with more than 800 doctors on staff, including 250 who are intensively affiliated with CDH. To improve clinical record data access for that very active physician group, CDH implemented a mobile rounding application that can be used inside or outside the hospital.

CDH clinicians can use Sprint PCS Vision Smart Device Treo 650s by palmOne along with the Horizon Mobile Car Rounding application by McKesson to gain wireless access to patient information both in and outside the hospital, including real-time access to laboratory and radiology results, vital signs, medication updates and patient history. Clinicians using palmOne Tungsten C handhelds, can also access patient information within the hospital using the same rounding application.

CDH wanted to make it possible for clinicians at the hospital to access medical information on a small handheld or smartphone screen so clinicians could walk from room to room and access the data they need. CDH wanted to use its wi-fi network to facilitate handheld access to the clinical record at the facility. In addition, CDH wanted to provide access to this information via a PDA or smartphone when clinicians were away from the facility using cellular wireless connectivity.

CDH already had a clinical portal set up that puts clinical record data into a browser-based view for anyone authorized to access that data. Because the Web-based clinical portal was already packaging clinical record data for the Web, Central DuPage knew it could be packaged for a small screen like a Tungsten C or smart phone. CDH knew that it needed a device-agnostic mobile data management solution that let clinicians use an application on their existing devices.

CDH purchased the McKesson Horizon Mobile Care Rounding application to support accessing the clinical record on a handheld or smartphone. By incorporating the latest smartphones like the Treo 650 using Sprint, CDH extended information access for clinicians beyond the hospital grounds, allowing them to access information from anywhere their smartphone connectivity was available. CDH had to ensure connectivity for all devices both inside and outside of the hospital.

“We have more than 46% of active staff using the technology. Anytime, anywhere access means higher productivity and faster service and better patient care, says Dave Printz, vice president and CIO, Central DuPage Health.

Military Use

The U.S. Army's Medical Communications for CombatCasualty Care (MC4). MC4 announced in March 2005 a deal with Insight Public Sector, a leading provider of IT products and services for federal governmental divisions and agencies, to provide over 11,000 Windows Mobile-based HP Pocket PC handheld devices with Pointsec for Pocket PC encryption technology to its medical staff. These devices will be used by Army medical professionals all over the world, and in particular, the combat situations in Iraq and Afghanistan.

The goal is to enable a comprehensive, life-long electronic medical record for all service members, and to enhance medical situational awareness for operational commanders. To meet that goal, MC4 has developed and deployed a medical information management system for Army tactical medical forces.

“MC4 is taking the technology of telemedicine and other existing automation systems in medical and support facilities and integrating those for combat support,” says Lieutenant Colonel Claude Hines, Jr., MC4 product manager, Fort Detrick, Md.

Moreover, MC4 links healthcare providers, medical diagnostic systems, information command and control, and medical command and control systems at all levels. And with the iPAQ used as a point-of-care hand-held assistant, enabling military providers to record, store, retrieve and transfer the essential elements of patient encounters by synchronizing the device with an MC4 laptop, handheld security is critical.

 “A key part of MC4’s mission is equipping front line medics with the tools they need to treat casualties in the battlefield. By providing point-of-entry systems for each encounter, MC4 is enabling the recording and sharing of real-time medical information with the touch of a stylus,” says LTC Hines. “Electronic medical encounters are critical for the soldier, the medical professional and the combatant commander, so by arming the handhelds with endpoint security technology, MC4 ensures this information is protected at all times.”

In February 2004, MC4 partnered with Johns Hopkins University Applied Physics Laboratory (JHU APL) to perform preliminary software testing on Pointsec technology, according to LTC Hines. Throughout the testing, MC4 concluded that Pointsec’s remote help feature, which can unlock the device and reset the password, is important for Army personnel because they are often miles from their technical support teams.

The application also offers user-friendly features and a 10-character length password that users must change every 90 days. MC4 also noted that Pointsec encrypts information on the handheld devices and regularly updates administrative and security policies, as well as issues technology updates to adapt to the latest hardware devices.

In addition to the Pointsec security technology, MC4 loads three other applications onto its handheld computers: the Post Deployment Health Assessment (PDHA); Battlefield Medical Information System Tactical, Joint (BMIST-J); and Symantec AntiVirus for Handhelds.

Katherine Thornberry is a Silicon Valley-based freelance journalist who writes about business, healthcare, real estate and technology. She can be reached at ktberry@batnet.com .