PDA & Wireless Technologies at the AMIA 2001 Symposium

By: Orin M. Goldblum, M.D.

Orin is a dermatologist practicing in Pittsburgh, PA and maintains a clinical affiliation as Clinical Assistant Professor of Dermatology at the University of Pittsburgh Medical Center. In addition to his medical practice, he is Director of the eHealthRx Service for Healthcare Industries Research Companies, a pharmaceutical industry research consulting firm based in Santa Cruz, CA. An early adopter of handheld electronic prescribing, Orin also serves as a consultant to ePhysician, a company improving patient care and practice efficiencies through clinical handheld services. He is the Moderator of the WirelessMedicalApplications listserv and maintains an updated forum for news items related to mobile computing on PDA cortex. In 2001, Orin published the first detailed evaluation of a handheld e-prescribing system appearing in a peer-reviewed medical journal. A member of the American Medical Informatics Association (AMIA), he recently proposed the formation of a new AMIA Special Interest Group for mobile computing. He is a 1981 graduate of the University of Pittsburgh School of Medicine in Pittsburgh, PA, and trained in dermatology at the Johns Hopkins Medical Institutions in Baltimore, MD. Orin resides in Pittsburgh with his wife Elaine and two sons, Alex and Michael.

Introduction

The 25th Annual American Medical Informatics Association (AMIA) Symposium, Medical Informatics Odyssey: Visions of the Future and Lessons from the Past, was recently held on November 3-7, 2001 at the Marriott Wardman Park Hotel in Washington, DC. Despite the recent DC terrorist attack and findings of anthrax-tainted facilities in the DC area, attendance for this popular informatics meeting was very good. Suzanne Bakken, RN, DNSc, Chair of the Scientific Program Committee, and her Committee members, did an outstanding job of planning and executing this educationally rich and diverse medical informatics conference.

The AMIA Annual Symposium consists of two full days of tutorials, followed by three days of panel discussions, oral presentations, posters, theatre-style demonstrations, workshops and a new presentation category for 2001, case study poster presentations, all spanning a broad range of medical informatics topics. In addition, the symposium offered various committee, working group and special interest group meetings, as well as social events and a product exhibition. A special panel presentation, The Informatics Response to Bioterrorism, Disaster and War, was held this year on Monday, November 5, 2001.

With the increasing popularity and usefulness of both handheld and wireless applications in health care, it was no surprise to find that of over 500 different presentations accepted for the AMIA 2001 Annual Symposium, a significant number were devoted to this new, emerging aspect of medical informatics. Close to 30 presentations at the AMIA 2001 Annual Symposium were on some aspect of handheld or wireless computing use in health care settings. Most were in the oral and poster presentation categories. Handheld computers were abundantly visible, with many attendees using these devices, with or without portable keyboards, to take notes during the symposium. A number of vendors exhibited software and hardware solutions for handhelds. As a presenter at the AMIA 2001 Annual Symposium, I attended the meeting from November 3-7, 2001. Although I was unable to attend every presentation on mobile computing, these are my observations from those attended and summaries from the remainder.

On Sunday morning, November 4, 2001, Lawrence B. Afrin, M.D., Assistant Professor of Medicine, Hollings Cancer Center and the Division of Hematology/Oncology, Medical University of South Carolina, gave an excellent half-day tutorial, Rapid Development of Mobile Applications: Theory and Practice. The tutorial covered PDA synchronization theory, design of a PDA-based application and PDA resources. Two examples of PDA applications, a straightforward medical office application and a more complex medical enterprise application, were used as demonstrations. Both were created with Pumatech's Satellite Forms. Dr Afrin's comprehensive PowerPoint presentations and other reference material from his Tutorial can be downloaded from these links:

Following this outstanding morning tutorial, on Sunday afternoon, November 4, 2001, Helmuth F. Orthner, Ph.D., Professor and Director, Health Informatics Program, Department of Health Services Administration, The University of Alabama at Birmingham, presented a tutorial, Emerging Wireless LAN Technologies for Health Care. Covering wireless communication, wired and wireless networking, next generation wireless LANs, 3G WANs and network security & management, this detailed tutorial was an excellent overview of wireless networks and their utilization in health care.

Two panel discussions included presentations related to mobile computing. The first was Important Trends for the Future of Clinical Computing, held on Monday afternoon, November 5, 2001. The panel was chaired by Dean F. Sittig, Ph.D., of Kaiser Permanente, who also created and edits The Informatics Review. Of the four presentations, Dean's was the only one related to mobile computing. His presentation discussed the role of handheld computing devices in the future of clinical computing. In general, he felt that because of deficiencies in input, security, synchronization, battery life and durability, the current generation of handheld devices will not significantly affect clinical computing. Judging from the question and answer session following his talk, this belief was not necessarily shared by audience members.

The second panel discussion, Electronic Prescribing in Ambulatory Care: Taming a Rapidly Evolving Market, was held on Tuesday afternoon, November 6, 2001. There were five presentations in this panel. Robert Elson, MD, MS, of McKessonHBOC, gave a general overview of e-prescribing and related issues. Vince Brannigan, a Law Professor from the University of Maryland, presented a discussion on FDA software regulation and validation. Mark Frisse, MD, MS, MBA, of Express Scripts, spoke about the U.S. prescribing infrastructure and why there are needs for both standards development and RxHub, an electronic prescription clearinghouse. Anne Carson, MPH, of the National Commission for Quality Assurance (NCQA), discussed NCQA's recent interest in e-prescribing, but mentioned they have backed off plans for accrediting and evaluating this market because it is still too small. Cedric Priebe, MD, of Allscripts, gave an overview of Allscripts' product line and software development.

Nine oral presentations were on topics related to mobile computing. Blum et al presented a study evaluating wireless WAN coverage within two academic medical centers. Cabrera et al discussed the use of a wireless telemedicine system in disaster situations. Carrol et al described the development of a PDA-based patient data and charting system in a neonatal intensive care unit. Lobach et al discussed the use of handheld devices for collecting medical information outside the clinical setting. Seckman at al presented an evaluation of clinicians' levels of acceptance and perceived usefulness for wireless laptop computers in patient care units.

Four presentations concerned handheld use in the educational environment. Manning et al presented a preliminary study on resident and faculty use and attitudes towards handheld computers. Speedie et al discussed a study on the usefulness PDAs as reference and data capture tools for medical students in a family medicine clerkship. Sumner presented an evaluation of a handheld encounter log used by medical students in a family practice rotation for documenting diagnoses. Thomas et al discussed a satisfaction survey of residents and medical students using a handheld version of a patient summary document.

During the two case study poster presentations, four presentations were on topics related to mobile computing. Curran et al discussed a handheld system for providing evidence based practice and point of care data entry in a nursing curriculum. Goldblum presented an evaluation of the performance and features of a new, wireless wide-area network handheld prescribing system, used in an ambulatory setting. Lindgren et al discussed a survey of handheld computer among third-year medical students during a clinical clerkship. Strayer demonstrated a handheld computer billing solution that was found to be effective for increasing the capture of hospital inpatient billing charges.

During the two poster sessions, nine posters were presented relating to mobile computing in health care. Afrin et al presented three different posters. The first described the development and testing of a mock PDA survey used for collecting information in the ambulatory setting. The second demonstrated the feasibility of integrating physicians' enterprise appointment schedules into a PDA calendar application. The third described the development and use of a Palm OS-based electronic medical record for accessing an enterprise clinical data repository. Chen et al related their experiences with handheld access to a wireless, web-based clinical information system in an institutional environment. Kennedy et al demonstrated a handheld-based CME program, allowing physicians to conveniently download programs from the web and view them on their PDA. Lynn et al showed interactive clinical practice guideline applications that can be used on handheld devices. SooHoo et al discussed lessons learned from the deployment of wireless LAN technology in a healthcare setting. Stoddard et al described the University of Arizona's experience with resident instruction and support for handhelds and various handheld applications. Strayer repeated his handheld computer billing solution case study poster in a poster session.

Duncan et al from Cedars-Sinai Health System, Los Angeles, CA, demonstrated their enterprise system of web-based viewing applications for clinical and administrative data. Their system is currently in use at Cedars-Sinai Health System. Secure access is available through in-house or remote workstations and through a wireless network, including via Palm VII PDAs.

A number of vendors at the AMIA 2001 Annual Symposium exhibited handheld and wireless hardware and software products:

Because of the significant amount of interest in medical handheld and wireless computing at the AMIA meeting, I spearheaded a grassroots initiative to develop a new Mobile Computing Special Interest Group (SIG) within AMIA. We needed a petition of twenty-five member signatures and quickly obtained double that amount. I am coordinating the efforts to get this new SIG approved by AMIA. If approved, the SIG will eventually have its own website and mailing list (for AMIA members) and will meet yearly at the AMIA annual meeting. The purpose of the SIG will be:

· To establish an interactive network for the exchange of information between AMIA members interested in the use of mobile and wireless technologies in health care.
· To develop educational resources and other learning opportunities for AMIA members interested in the use of mobile computing in health care.
· To encourage the study and advancement of mobile and wireless point-of-care technologies that can improve outcomes and reduce health care costs.
· To promote increased adoption of mobile computing health care technologies in the educational, clinical and research settings.

PDA & Wireless Presentations at the AMIA 2001 Annual Symposium, November 3-7, 2001, Washington, DC