Hospitals and health plans roll out PDA programs
Early efforts let physicians retrieve—and in some cases, change—patient records via palmtop computers
Copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.
By Bryan Walpert
When Amita S. Shetty, ACP-ASIM Member, rounds at Southeastern Regional Medical Center in Lumberton, N.C., she has much of the patient information she needs right at her fingertips. She uses her Palm to view patient demographics, date of admission, lab results and radiology reports directly from the hospital's computer system.
"It saves me at least an hour a day, and it eliminates a lot of aggravation," said Dr. Shetty, an internist at Medical Specialists Clinic, a four-physician practice in Lumberton.
Large hospitals and medical centers already give physicians online access to patient information on personal computers located throughout the hospital. But many institutions are starting to offer them some of that same information through handhelds.
Many large hospitals are investigating or rolling out programs that give physicians access to patient data via personal digital assistants (PDAs). Hospitals and health systems are banking on big gains from handheld computers, convinced that the technology can improve efficiency, help prevent medical errors and save them money by reducing patient days.
Here is a look at some of those early efforts.
One-way communication
A number of large institutions have launched PDA programs with one-way communication that let physicians use their handheld computers to tap into patient information.
At Saint Francis Hospital in Tulsa, Okla., for example, rounding physicians can use their PDAs to view demographic information—name, birth date, weight, allergies, diagnosis—as well as basic laboratory results like blood chemistry, liver function, prothrombin time and differentials.
Physicians can also access patients' list of current medications and fluid intake and output, as well as their last three readings for temperature, pulse, respiration and blood pressure.
The physicians download the information into their PDAs at synchronization or "hot sync" stations around the hospital. "You end up being able to review a patient's basics in the time it takes to wait for an elevator," said Stanley N. Schwartz, FACP, medical director of infectious disease services and clinical information at Saint Francis. "Having that information is a great help when you're sitting with the patient and you don't have the chart."
Novant Health's 10 hospitals in Charlotte and Winston-Salem, N.C., take one-way access a step further. While physicians can tap into patient data via sync stations, they can also wirelessly access their dictated notes as well as patients' medication histories and lab and radiology results.
Novant began offering the service last year to 40 pilot physicians. After word spread about the program, however, demand grew. Today, more than 350 Novant Health physicians use PDAs to electronically access patient information.
Two-way communication
Some hospitals are expanding PDA applications by experimenting with two-way communications where physicians can enter patient information as well as receive it.
Good Samaritan Hospital in Baltimore, Md., for example, is testing a system that allows internal medicine residents to enter progress notes directly on their handhelds and send them wirelessly to the hospital's information system.
To keep data entry to a minimum, residents' PDAs will feature drop-down menus with pre-selected phrases such as "patient is resting comfortably" or "denies chest pain or shortness of breath." Residents will be able to use the previous day's notes as a template to avoid reentering a lot of data, while attendings will be able to add observations to residents' notes.
University of Iowa Health Care in Iowa City is in the planning stages of an even more ambitious PDA-entry system for its hospital. The program will use PDAs to document medication administration and identify tissue and blood samples.
The hospital plans to issue a request for proposals to vendors by next year. Eventually, hospital nurses will be able to use PDAs equipped with readers to scan barcodes on both patient ID bands and medications to ensure that the right patient is getting the right drug.
Similarly, a nurse drawing a blood sample would use the PDA's barcode reader to identify the patient and create a label (printed out nearby) for the blood tube before sending it to a blood bank or lab. And when a unit of blood is sent for a transfusion, a PDA scan would confirm that a particular unit corresponds to a specific patient or alert the nurse that a blood order has been cancelled.
The next step: order entry?
Physician order entry would appear to be the next logical step in the evolution of PDA applications in large hospitals. But even some hospitals that permit order entry via computer terminals are stopping short of offering it with PDAs. The reason? Hospitals aren't sure yet whether a device with such a small screen is ultimately the best technology for the job.
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Hospitals are considering making order entry available through handheld computers, but some worry that PDA screens are too small. |
"I would like to get physician order entry up and running and use the PDA to do it," said John Jenkins, vice president and chief information officer at Moses Cone Health System in Greensboro, N.C., which lets physicians tap into patient information through their PDAs. "I'm concerned about screen real estate. I don't know how feasible PDA order entry is going to be."
Many institutions also want physicians to use PDAs to replace cumbersome verbal orders with electronic order dating and signing. At Evangelical Community Hospital in Lewisburg, Pa., physicians must sign an order they've given over the phone within 24 hours—one of the main reasons the hospital is looking into PDA applications. Right now, hospital staff spends too much time tracking down physician signatures.
"It's inconvenient for physicians," said Scott Peterson, vice president and chief information officer. "And the hospital would get a lot of benefits from that application as well."
St. Clair Hospital in Pittsburgh, which lets physicians use their PDAs to request medications, labs and X-rays, is ahead of the curve when it comes to order entry. Thomas Ague, St. Clair's executive vice president and chief operating officer, said that instead of "spending their day in front of a five-foot stack of medical records looking for where to sign," physicians can sign medical records or orders from outside the hospital via either a regular PC with a browser or an iPAQ (a PDA from Compaq) on a cellular network.
Giving physicians information sooner means they can act on it more quickly, Mr. Ague pointed out. That means physicians can make more timely decisions about whether a patient needs to be in the hospital.
"If we can move two patients out one day earlier over the course of a year," he said, "we've recouped the cost of the iPAQ."
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