The Rise of Palmtop Technology in Medicine Part 1

By: E-Healthcare Connections www.e-healthcare-connections.com

E-Healthcare Connections ("EHC") is an information intermediary and publisher servicing a broad audience of high-level healthcare industry executives and physician leaders. EHC reviews, analyzes and reports on developments in the healthcare Internet in order to assist its readership and viewers to better comprehend the practical applications as well as the strategic implications of the burgeoning healthcare Internet community.

This article is republished with the kind permission of John D. Cochrane Editor & Publisher Health System Executive & E-Healthcare-Connections

John can be reached via email

While health care IT executives ponder the meaning of HIPAA, a quiet revolution is taking place in the hallways, at the bedsides, and in the clinics of the nation's hospitals. It's the rapid deployment of both clinical and adminstrative information to and from the palmtops of physicians. It's a development that may hold the solution to the health care integration puzzle.

Personal digital assistants, or PDAs, will play a vital role in the future of health care information technology, according to a panel of vendors speaking at the January 28th Annual HIMSS Conference and Exhibition in Atlanta.

Wireless PDAs offer three fundamental capabilities to caregivers and other health care I.T. users, according to Stephen C. Wilson, research and development manager at Welch Allyn Inc. They can simplify workflow, optimize productivity, and enable real-time access to health care data anytime
and anywhere.

As it stands, not quite 20% of physicians use PDAs today. A show of hands at the HIMSS educational session, titled “The Future of Wireless PDAs in Health Care,” indicated that an overwhelming majority of the more than 500 people attending the session use PDAs today. Of those, about one third have real-time wireless services, and about 20 use their PDAs for clinical applications.

Physician use of mobile devices and applications - including electronic prescribing, charge capture, charting and others - is expected to fuel an industrywide sales leap. Sales should grow 214% from 2001 to 2002, according to Forrester Research Inc., Cambridge, Mass. Forrester predicts sales of hand-held devices and applications used by doctors will grow from $19.4 million in 2001 to $60.9 million in 2002 and $181.35 million in 2003.

At the root of this growth are physicians who began using PDAs as appointment books to manage daily schedules and store addresses and phone numbers.

The next phase was physicians tapping PDAs - which today range in price from approximately $200 to $800—to access reference information on drugs, including interactions and dosages.

According to a study conducted this fall by The Boston Consulting Group and Harris Interactive, 22 percent of doctors use electronic medical records to store and track information about their patients, and that number is expected to double by spring 2003. BCG and Harris interviewed more than 400 U.S. physicians for the study, titled Doctors Say E-Health Delivers.

For some organizations, the next step will be to install systems for physicians to write prescriptions on hand-held devices.Prescription writing via hand-helds is eliminating the legibility problem and cutting costs by decreasing telephone interplay among provider organization staff and pharmacists.

In addition to physician group practices and hospitals, other health care organizations, including managed care and public health organizations, are implementing hand-held technology. Examples of new hand-held technology use abound.

Physicians at Stanford (Calif.) University Medical Center access radiological images via PDAs. The medical center is using a wireless infrared network from Clarinet Systems Inc., Milpitas, Calif., to extract data from a picture archiving and communication system from GE Medical Systems, Milwaukee.

Horizon Blue Cross and Blue Shield of New Jersey is sponsoring a pilot program for physicians to gather and transmit patient data at the point of care. Physicians use hand-held devices and software from ePhysician, Mountain View, Calif., to write and transmit prescriptions, view drug formulary compliance information, capture billing data, and access clinical data.

Blue Cross & Blue Shield of Rhode Island (BCBSRI), Rhode Island Primary Care Physicians Corp., ePhysician and PharmaCare have begun an electronic prescription program, with 42 primary care physicians in Rhode Island, seeking to reduce the number of prescription errors caused by illegible handwriting. The pilot program, part of Project BluePrint, has the support of the Rhode Island Department of Health and Board of Pharmacy. As part of the six-month pilot program, BCBSRI is providing Palm handheld devices and the first six months of the monthly ePhysician subscription fee at no cost.

At the end of the trial period, participating physicians will keep the Palm devices and may continue in the program by assuming the subscription fee. While the program’s main purpose is to increase the legibility of prescriptions, the ePhysician application also provides a software program that contains information on drug-drug interactions and updated formulary information. The software also allows physician’s offices to review a prescription if the doctor
is out of the office. In compliance with current regulations, physicians will not transmit prescriptions for Schedule II controlled substances through the ePhysician system, which must be handwritten. Visit http://www.ephysician.com for more information.

Saint Francis Hospital in Tulsa, OK is using connectivity software from Tulsa-based Locker Consulting Inc., which the company developed with Per-Se Technologies Inc., Atlanta. The software brings to physicians palmtop only select clinical data: height, weight and allergies; lab results; and medications prescribed and administered. Most physicians in the program are using Palm PDAs. The system is expected to include devices using the Pocket PC operating system by April.

Saint Francis Hospital piloted the new hand-held system in August and began rolling it out in October with five physicians. The hospital is targeting more than 100 doctors. Data available to the PDAs is updated hourly, and most physicians download the data from syncing stations.

The system also enables non-Palm devices to download data via infrared syncing, a process that takes up to two minutes for data on 10 patients, compared with 20 seconds through the fixed cradles, Paulson explains.The only cost to physicians is that of the PDA. Syncing stations range from $30 to $120.

The hospital has a radio frequency-based wireless network in place that’s used for entering patient vital signs via cart-based laptops. The physicians found the laptop system too difficult to work with.

In late January, MercuryMD announced that Novant Health System - located throughout central North Carolina is rolling out MercuryMD’s MData En-terprise System to 300 health professionals during the next six months.

Novant Health is a not-for-profit health system with hospitals and physician practices in the Winston-Salem and Charlotte regions, serving more than one million people in 32 counties. The health system consists of seven hospitals with approximately 2,000 licensed beds.

Novant Health completed its implementation of MercuryMD’s MData Enterprise System in December 2001 with 30 physicians participating in the pilot plan. Based on the successful pilot, Novant plans to roll out MData to 150 physicians by mid-March with an additional 150 using it by June 2002.

According to Toni Kourey, Chief Information Officer, achieving those numbers is not expected to be a challenge. “We have received an overwhelmingly positive response from not only our IT staff but also from the physicians currently participating in the pilot program,” said Kourey “Our IT team is pleased with how smoothly the installation went and our physicians praise how convenient - and time-saving - it is to have patient data at their fingertips without having to go track it down.”

Physicians and pharmacists at Moses Cone Health System, Greensboro, N.C., a five-hospital system, are accessing patient data from an electronic medical records system via PDAs. Clinicians get patient data by syncing via a mobile infrared system that enables them to review patient demographic information, diagnosis, lab results and medications using an application from MercuryMD Inc., Research Triangle Park, N.C. The system runs on a server from Extended Systems Inc., Boise, Idaho.

The system went live in October with about 100 physicians on board by month’s end. They hope to end up with at least half of the 600 physicians enterprisewide using the system. Doctors at Moses Cone can use their Palms to access patient records from an EMR system by IDX Systems Corp.,
Burlington, Vt. The handheld system soon will accommodate devices running the Pocket PC operating system.

The goal was to pull out the most vital information from the patient’s electronic medical record. The hand-held system can show up to 2,000 characters of a transcribed report within the electronic record.Physicians were quick to accept the new system last summer. Less than three months later it went live.

According to Patrick Wright, a pulmonologist and critical care physician at Moses Cone Health System, “Once or twice a day before rounds, I would have
to spend at least an hour and a half sitting in front of a computer terminal, looking up my patients’ data and writing down information on little scraps of paper that I would take with me.” MercuryMD was an unknown startup company based in Durham, N.C. MercuryMD founders were residents at Duke.

“The main problem in healthcare IT is that the systems that do exist don’t get used,” says MercuryMD CEO Alan Ying. Rolling laptops - where a laptop is attached to a cart for the doctor to roll from room to room - cannot be carried easily from floor to floor, and even laptops are too cumbersome for most doctors to use while examining a patient. Worse, many doctors are notoriously technophobic. Ying believed the Palm PDA was a way around these barriers, since a growing number of doctors were already using them for calendaring and other tasks. But MercuryMD did not yet have any customers,
or even a beta user, when Ying visited Moses Cone.

Health system CIO Jenkins was extremely skeptical but was willing to go along with a 90 day pilot. Jenkins picked a group of about 20 doctors to participate in the pilot. As part of the deal, they had to have their own Palm OS device. Moses Cone did not charge them for the application. The initial pilot group was up and running with MData in April 2001. Moses Cone’s IT staff ended up putting in about 100 hours for validation and testing, but MercuryMD took care of linking the software into the hospital’s primary IDX LastW ord Admission, Discharge, and Transfer system. The MercuryMD team also built links to the hospital’s other major data sources, including a Cerner radiology system, a SunQuest lab application, an IDX pharmacy system and a MedQuist transcription system. In a matter of a few weeks, the users were ecstatic about the MData application, according to Jenkins.Sixty days into the pilot, a survey completed by all of the users confirmed the positive reviews.

To use the system, doctors insert their Palm into a Clarinet sync station (located in the physicians’ lounge, near the elevators, and in a few other spots around the hospital), input their PIN and other security data, and wait for the download to complete, a process that takes about two or three minutes. Then they can go about their rounds, armed with nearly real-time clinical information such as lab results, notes, and medication information.

“If a patient asks what were the results of his bone scan, I can pull that data up right then,” says Wright. “I can check chemistry and labs and all the vital information that is supposed to be in the patient’s chart but usually isn’t.” If Wright has a question about a drug, he can look it up in the ePocrates drug database right on his Palm and get an immediate answer. Compared to hunching over a PC scribbling down numbers, taking the time to get to a sync station and download the latest data is nothing, says Wright. “This saves me so much time.”

Jenkins rolled out the MData system to 300 doctors and pharmacists - about half of its medical staff - in November 2001. He is in the process of deciding whether to expand the project to all the group’s doctors and nurses, and whether to charge them for the application. The current version of the system is read-only. Future MData versions may support limited physician data entry, such as the ability to input billing information. Jenkins is sure Moses Cone will get a return on its investment in MData, but he’s leery of trying to quantify it yet.

“I’m willing to bet that this doesn’t show up on anyone’s bottom line - at least not right away. Right now, we have no evidence that it will do anything other than save people time.” But that is enough of a contribution, he says. “In the long run, it will save us dollars. You just can’t put your finger on it and count that today.”

Another bonus: The infrared system lets him postpone investing in a more costly wireless data network, which he says he will have to do in the next two years or so. The MData system will help cut down on errors, raising patient and physician satisfaction, by giving doctors near-instant data that they previously had to struggle to access. Says Jenkins, “We will get back way more than we invest.”

Some 15 pharmacists were using the hand-held system by December, says Jan Stafford, a systems analyst and pharmacist. The hospital pharmacy purchased eight PDAs that are shared among about 15 pharmacy staff at any given time. The PDAs in use are Palms or devices from HandEra Inc.,
Des Moines, Iowa, formerly known as TRGpro. Time savings in the Moses Cone Hospital pharmacy are estimated to be at least 60 minutes a day, multiplied by 15 pharmacists earning $30 to $50 per hour. Savings on the physician side are estimated to be 30 to 90 minutes a day during patient rounds from bypassing workstations and the time associated with printing patient data on paper. Savings played a major role in Moses Cone Health System’s decision to buy an infrared-based hand-held system as opposed to a wireless, radio frequency net-work.

Infrared “beaming” technology is common among PDAs. Cost per location is about $65,000 compared with about $500,000 for a similar wireless infrastructure. The delivery system spent about $250,000 on the initial implementation.

Moses Cone wants to relieve stress on its 3,000 nurses, as well. So it plans to pilot a hand-held nursing system this year, says Jenkins, the CIO. He believes the technology has great potential for another big step for his organization as well as many others: physician order entry.

Doctors at the delivery system aren’t doing any data entry yet, but the hospital is working with MercuryMD to explore the possibilities.

Temple Physicians Inc. in Philadelphia is implementing a prescription management system from Allscripts Healthcare Solutions Inc., Libertyville, Ill.. The delivery system includes six hospitals, long-term care, homehealth and a 320-physician group practice based in the medical school. According to chief medical officer, Eric Mankin, M.D., chief medical officer, charge capture was important to Temple Physicians, but even more critical was the need to combat rising costs. “We were facing 20%-plus increases in pharmacy costs in our hospitals, where we accept risk for thousands of patients,” Mankin told local reporters. The Allscripts software allows doctors to write and track prescriptions and manage drug formulary compliance, in addition to accessing clinical decision support. “We wanted to show we were formalizing a plan to minimize our malpractice risk, and prescribing is one obvious area,” says Mankin, who was named 2001 Physician of the Year by Microsoft for excellence among physicians using PocketPC-based mobile devices to improve quality of care.

The hand-held system operates on a PocketPC platform and data is transmitted on a wireless network from Lucent Technologies, Parsippany, N.J. Physicians access data residing in the organization’s practice management system from IDX Systems Corp. via iPAQ devices from Compaq Computer
Corp., Houston.

The organization piloted the system in three physician practices in autumn 2000 and began implementation in early spring 2001.Wireless electronic prescribing was phased in from April to September and included 135 physicians last month. Early results showed that physician prescribing patterns are conforming to drug formulary requirements since the system went live. “Between a quarter and a third of all prescriptions show a suggested alternative,” Mankin says. “About 70% of these alternatives are accepted, depending on the doctor and the practice. We ’ve seen a rise in total generic drug prescriptions from 39% to a little over 50%.”

W e hoped to improve the office efficiency of practices,” Mankin says, “because 50% of their phone calls are related to drugs, including patients and pharmacies calling about nonformulary drugs and checking pre-scriptions.” His group hoped to reduce front desk staffing ratios and already has seen a reduction in the number of calls from pharmacies. He attributes this to decreased drug interaction problems and incorrect dosages related to physicians having the PDA access to more data.

Carle Clinic physicians, nurses, nurse practitioners and physician assistants all use Palm devices that access patient data and track outpatient service charges via a charge capture application from Durham, N.C.-based MDeverywhere. Clinicians use PDAs for all outpatient visit charges, with an eye on preventing lost charges and decreasing the lag between the time of a patient visit until the charges are entered into the system. Carle Clinic is on the way to its goal of
getting 98% of charges into the billing system within two to three days. Before the new charge capture system was implemented in June, the rate was about 90% within seven days. They are about halfway to the target.

Clinicians start their day by syncing with a patient scheduling system from Epic Systems Corp., Madison, W is. Then they enter services and procedures performed throughout the day. The charge capture system compares charges with CPT and ICD-9 codes to ensure correct coding. Another feature of the new system is that charges are automatically checked against code sets under Local Medicare Review Policies set by CMS. Nearly 70 clinicians were using the system in December. The clinic hopes to have at least 200 of about 345 physicians and midlevel providers using the system by year’s end.

That goal seems reasonable given the results of a survey conducted 90 days into the implementation. Physicians reported a 98% approval rate. The system already is producing cleaner data and more thorough charge capture and charge tracking.

Return on investment so far is measured in terms of eliminating paper forms and their resulting storing and filing expenses. Costs are running about 65% of the paper-based system.

That figure compares favorably to ROI numbers recently publicized by MDeverywhere that are based on reports from seven organizations using hand-held
devices to collect patient encounter data at the point of care. The studies compared claims administration efficiency for a 90-day period before and after rolling out the devices. Overall, the provider organizations reduced lost income due to misplaced encounter forms an average of 95% and slashed lost income from miscoding by 66%. Daily charge downloading to a practice management system cut claim write-offs by 85% and trimmed the number of days to reimbursement by 64%, the study showed.

The Carle Clinic intends to pursue more PDA applications. It expects to pilot a wireless network in one of the organization’s 13 branch locations this year. The goal is to enable access to electronic medical records, lab results and further charge applications.

Handheld pen tablet computers will also play a key role. The pilot device likely will come from Fujitsu PC Corp., Santa Clara, Calif., and will interface with the charge capture system. The wireless system will be introduced enterprisewide, including the organization’s core hospital.

Other applications already in place include medical residents using Compaq iPAQs to get class assignments. The organization also is exploring digital dictation via PDA.

The University of Iowa Hospital selected a Windows CE-based system for its wireless handheld PC solution. Dr. James Flanagan was a key decision-maker involved with the selection. He is an associate professor of clinical internal medicine who treats patients and teaches medical students. He also is director of clinical informatics for the computer patient record program at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. In that role, he selected the W indows CE-based Intermec 6651 handheld for the task of migrating from desktop PCs in the exam rooms to mobile computers. Dr. Flanagan chose the 6651 mobile device for several reasons.

The order entry piece drove us to wanting this technology, he says. Doctors movefrom room to room every 5 to 30 minutes. We wanted to introduce the convenience of a personal wireless workstation so the physician could be logged in all the time. We wanted to collect information in real-time while the physician was with the patient. That way the physician could enter data into the handheld simultaneously and not have to do it as a separate task after the
patient left. That not only saves time for the doctor, but entries on the handheld automatically generate orders for the nursing staff (draw blood, take tissue samples, administer a medicine) and sends prescriptions directly to the pharmacy.

We were looking for a device to give our outpatient physicians mobility, while maintaining connectivity to the network so they could access up-to-date patient information in real time.

W e needed a handheld with a larger screen, bigger than a Palm device, that had touch capability and a keyboard. Even though the 6651s are pen computers, there is still a need to type in short pieces of text or individual words in order to search for something. A comforting part of the transition from desktop to mobile PC is that the screens on the handheld computers look just like those on the desktop. That drastically reduced training time and permitted the physicians to begin working with the units quickly.

About 100 physicians practice in the university’s General Medicine outpatient clinic and visit with patients in some 36 exam rooms, many of which are equipped with hard-wired desktop PCs used to access W indows-based INFORMM Patient Record (IPR), the patient record program developed by the hospital. Now, with the new wireless network in place, IPR is accessible via the mobile computers.

Through IPR physicians access patient lists, order tests, review the results of tests and prescribe medications in real time. They can even call up images of patient x-rays on the 6651’s 7.1 inch diagonal screen and view them.

W hen developed over 20 years ago, INFORMM was hosted on a mainframe computer. Six years ago it is moved to aWindows client server model. The next step is development of an XML version to migrate parts of the program to a W eb-based application, a move that is currently underway. Today, about 10 physicians are using the 22-ounce model 6651 handheld units instead of the desktop units during patient visits.

Doctors report several benefits to using the mobile PCs while treating patients. They can:

Perhaps the most important benefit of sharing real-time data about patients throughout the healthcare facility is the increased level of visibility it provides. For
example, we may have new data in the nursing database that suggests the patient’s blood pressure is too low to be given a certain medication prescribed sometime earlier by a physician, Flanagan said. A physician can move quickly to prevent a dosage problem if they see other information we have on the
patient. It’s important that all patient information be updated in real-time, since it is accessed in real-time. Flanagan did not want to rely on a docking port to upload and download data minutes or hours after the patient visit. The information by then may be out of date.

One thing that’s driving our use of wireless mobile computing is the need to comply with Medicare regulations, Flanagan emphasized. That means making an appropriate diagnosis, prescribing the appropriate tests or treatments and making sure the hospital receives payment for services rendered. Our system is designed to automatically check to determine whether or not a test I might order for a Medicare patient is ‘reasonable and necessary.’ The business rules for Medicare are written into our system, and that helps reduce the time needed to determine whether a patient will have to pay for a Medicare treatment. The doctor enters the test he or she wants to order, enters the diagnosis and checks against Medicare regulations. If approved by Medicare, the physician proceeds to order tests or treatments. If the test is not approved by Medicare, we can see it on the handheld right away and can alert the patient that if she
wants the test she will have to pay for it.

Monthly Local Medical Review Policy updates to the IPR software ensure that the records system complies with the latest rules on what Medicare will and will not allow. The handheld also provides feedback to physicians on the local medical review policy, or LMRP, which includes information on tests that are typically ordered for specific diagnoses.

W ireless connectivity between the 6651 handhelds and the thin client Citrix server is established through seven Intermec 2101 access points strategically placed through-out the outpatient clinic. Access points are radio frequency transceivers, usually installed in the ceiling, which permit the wireless mobile computers and the server to communicate. Citrix software allows any application that runs on a desktop PC to run on a properly configured mobile computer.

Each handheld contains a standard 2.4 MHz 802.11 compliant radio card to communicate with the server via the access points. Built-in W ired Equivalent Privacy, or W EP128 protection, provides a high level of security on the Intermec wireless network.

Patients find the handhelds pretty unobtrusive, Flanagan said. They do seem to notice if you are checking on their records in front of them, and they do appreciate it because they see you are really up to date on their information.

On the other side of the screen, it did not take much effort to convince some of the physicians in the clinic to begin using the 6651 mobile computers. There’s always a certain set of physicians who are most eager to be involved in these kinds of things, Flanagan said. We had several volunteers come forward to try these handhelds. They were early adopters who were looking for solutions to the problems they face in the practice of medicine. Physicians are finding that with our application, which is designed to show a lot of info on the screen, they can adjust the flow of information. They like that very much.

What ’s the next technology move at the University of Iowa Hospitals and Clinics? Dr. Flanagan says he’s ordering more mobile equipment for the clinics to replace the fixed location PCs in the exam rooms. Flanagan expects to add a medication administration record (MAR) software package to the system. When the MAR package goes live, bar coded patient bracelets will be introduced to further enhance patient safety and reduce medical errors. Wireless handheld computers with built-in bar code scanners will be used to scan the patient bracelet before medicines are administered to ensure the right patient gets the correct dose at the proper time.

Even though healthcare compliance issues may be driving the implementation of wireless technology at the University of Iowa Hospitals and Clinics, Dr. Flanagan is expecting improved patient care and safety. That’s a prescription the healthcare industry can take in good conscience.

Concentra Managed Care Services Inc. began a pilot project for using PDAs in case management early this year. The software is a project management application from Changepoint Corp. in Toronto. The PDA-based software tracks and manages referrals; manages resources, schedules and workflow; and generates invoices for 1,200 case managers and administrators located throughout the United States and Canada, says Larry Carr, president of Concentra’s case management division, based in Waltham, Mass.

Concentra Managed Care Services had several goals for its new system. “First, we wanted more accurate and timely communications from the main office to remote case managers,” Carr says. “We wanted to improve the quality of our data and improve the case manager’s quality of life. To do that we had to reduce the administrative burden on them so they could allocate more time to practicing their art.”

Changepoint software, accessed via iPAQ devices, enables Carr to take existing information systems that capture assignments from client insurance companies, third party administrators and their customers, and package and deliver them to the appropriate case manager. And it’s all accomplished effortlessly, Carr contends, by “hot syncing” the iPAQ with the central database. Case managers exchange data by syncing their iPAQs through a cradle connected to a virtual private network or encrypted dial-up line via the Internet.

On another level, the hand-held system can relieve the administrative load on case managers by enabling more timely communications. “The software lets them record their activities, time and expenses,” Care says. “And voice recording capability enables them to dictate clinical notes on the fly.” The software accumulates all the data and produces a record of billable, or appropriate, charges.

Case managers save up to three hours per night that no longer is dedicated to paperwork. At the same time, Concentra Managed Care Services gets cleaner, more complete data from its field force, helping them reduce errors and resulting expenses. Costs for the hand-held system, includ-ing
hardware, software, and internal and external transition labor are expected to fall between $3 million and $3.5 million, Carr says. “W e expect to reach the break-even point before the end of the year,” he adds.

The next generation of hand-held tech-nology, available in two years or sooner, will enable entering full clinical notes on handheld devices, Carr says.

In mid-January another health system announced going with MercuryMD: Leading Healthcare System Quantifies Efficiency And Enhanced Workflow By UsingMercuryMD’s MData Hospital System’s Annual Estimated Savings To Exceed $500,000 Research Triangle Park, NC; January 16, 2002 - MercuryMD, a company that integrates hospital data and delivers patient information to healthcare professionals’ handheld devices, today announced that user research from Baptist Health - Arkansas’ largest healthcare system - in Little Rock, Arkansas shows MercuryMD’s MData Enterprise System saves money, allows healthcare professionals to spend more time with patients, and significantly expedites the hospitals’ clinical workflow process.

David House, Baptist Health Chief Information Officer, expects that the time savings achieved with MData will enable his organization to redeploy about 11 full-time employees, thus saving the company $550,000 annually in staffing costs alone. In Baptist Health’s survey of MData users, nearly 70 percent of respondents said they used their time saved to spend more time with their patients. “Spending more time with patients translates into improved quality
of care,” House said. The survey also found that:

Additional cost-avoidance analyses from Baptist Health estimates that hospital staff will save a combined average of 63 hours per day by year-end, since they no longer had to manually gather patient data for physicians and themselves. The group with the most significant time savings were nurses, who often spent a significant amount of time gathering data for physicians before physicians began using MData.

According to House, MercuryMD’s seamless integration into the hospital’s existing IT systems, and the simplicity of the MData user interface were major selling points for the Baptist Health IT staff. “One of our driving principles is to offer technology that maximizes adoption, and this survey research demonstrates the usability and benefits of the MData Enterprise System.

These results serve to validate our compelling value proposition, not only for the hospital, but for MData users as well,” says Alan J. Ying, MercuryMD’s CEO. Baptist Health is Arkansas’ largest healthcare pro-vider. A teaching healthcare system, the company has five hospitals, 1,200 beds and 7,000 employees.

Palms are starting to be as common as stethoscopes in Seattle. The University of W ashington ’s OBGYN department and Swedish’s family practice program hand out Palms to residents who don’t already have them.

“Our residents use them for gathering statistics,” said Dr. Dee Fenner, an associate professor of obstetrics and gynecology at the UW . “We have to keep very accurate specifics, in terms of the number of surgeries they perform, the number of outpatients they see and the number of babies they deliver.
W e have forms that are put out by the Residency Review Committee that have been adopted for the Palmt.”

Fenner said her residents began testing Palm use three years ago, but it wasn’t until this year that her program eliminated the paper tracking system. Residents store all kinds of information that helps when counseling patients. They can have data on ultrasound measurements, labor and delivery, and various lab values right in the palm of their hands. They also often exchange information by “beaming” tables and databases from one handheld to another. Doctors have pointed to ePocrates’ ePocrates Rx, which is available free on the Internet, as a particularly valuable tool, The San Carlos, Calif., company that created the database, (www.epocrates.com) says ePocrates Rx™ provides doctors with an electronic guide to the most commonly prescribed drugs. The database has reached more than 94,000 of America’s 600,000 physicians since it came out in late 1999.

“Handheld technology works well with the way that a physician practices medicine,” said Michelle Snyder, vice president of marketing and strategic planning for ePocrates. “They’re not sitting at their desks during the day. They go to clinic or the hospital or maybe the emergency room. It’s perfect
because they have the information with them wherever they may go.”

The convenience factor also makes it more likely that doctors will check for drug interactions. “If I’m in a room with a patient and I have to go outside to my library to look up a drug, that’s just not something I am likely to do,” one resident says. “But I carry my Palm in belt. If all I have to do is pull it out and look it up, I am much more likely to do that.”

In a study of ePocrates users conducted by a Harvard Medical School teaching affiliate hospital, half the physicians who participated said that ePocrates Rx 4.0 helped them avoid at least one adverse drug reaction each week, according to the company.

Columbia University School of Nursing, New York, has outfitted its students with Palm m500 handheld computing devices from Palm Inc., Santa Clara, Calif. Loaded with software from ePocrates Inc., San Carlos, Calif., the handhelds give students point-of-care access to medication dosages, side effects and other drug information.

The university also has loaded self-developed software enabling students to document their experiences, including diagnosis, intervention and outcomes data, for later analysis by hospital officials. Collecting some of the data also is a requirement for professional credentialing.