Just as many Third World countries with poorly developed communication systems are skipping the traditional telephone networks and going straight to wireless, physician practices are coming out of the technological dark age with the help of mobile computing devices: personal digital assistants, laptops and the latest generation of cell phones.
"This (technology) is not aimed at the tech-savvy resident," says Alan Ying, M.D., CEO of MercuryMD, a Durham, N.C., company that integrates hospital systems and delivers clinical data to handhelds. "This is aimed at the 70-year-old orthopod with bifocals who can't even program a VCR."
"Wireless may just be the stimulus that moves us toward an electronic health record," says Claudia Tessier, executive director of the Mobile Healthcare Alliance, a Washington, D.C.-based group formed in 2001 to promote wireless and mobile technology in healthcare informatics.
More than 50% of healthcare informaticists responding to a Medical Records Institute survey in spring said their organizations had implemented mobile laboratory data retrieval. Nearly 40% said they check drug information on mobile devices.
The Newton, Mass., Medical Records Institute, which hosted its second annual conference on wireless healthcare technology in October, warns that those numbers may be artificially high, as the survey sample was taken largely from tech-interested attendees at its annual TEPR trade show.
Starting small with handhelds
The PDA appears to be the catalyst for physician adoption of mobile technology, says J. Peter Geerlofs, M.D., CMO of information technology vendor Allscripts Healthcare Solutions, Libertyville, Ill.
"How the heck do we overcome the fact that there have been many, many more failures than successes over the last 30 years?" Geerlofs asks rhetorically. "Often, physicians just starting out in this are willing to try the PDA (before going to a PC)."
Doctors with IPC-The Hospitalist Co. carry Hewlett-Packard Jornada mini-laptops in their coat pockets. They dial in via cellular connection to IPC-Link, a remote interface to the North Hollywood, Calif.-based company's billing, EMR and clinical decision support systems. (Soon they will migrate to iPaq PDAs.)
"All our docs are employees, so they have to use the system," explains Mary Jo Gorman, M.D., vice president for clinical affairs.
The system captures charges and clinical data, along with allowing for communication with primary care physicians and performance benchmarking.
"It creates the fully connected physician," Gorman says. "The central office can know everything the docs saw," she says.
When orthopedic surgeon John Carrozzella, M.D., opened Sand Hill Bone and Joint, a solo practice in Plant City, Fla., a year ago, he made sure his iPaq was linked to his Medical Manager billing system for charge capture and charge management.
"I find that I have virtually zero lost charges in my office," Carrozzella says. "The time for charge entry and review has dropped down to almost nothing."
The iPaq also connects to a ProxyMed e-prescribing system by wireless network.
Carrozzella has four full-time employees, below the median of five full-time equivalents the American Academy of Orthopaedic Surgeons says is typical of solo practitioners in the specialty.
"My wireless office, my computerized office, allows me to cut down on the number of staff," Carrozzella says.
Operating without wires
The Ohio State University Medical Center in Columbus is in its second year of an ambitious mobile healthcare initiative. Since August 2001, OSU has deployed 1,600 PDAs-mostly Palm Pilots-to residents and third- and fourth-year medical students. "I think this technology has been adapted faster than most technologies," says Andrew Thomas, M.D., assistant medical director at OSU.
The young physicians and medical students can use their PDAs in four different arenas: personal applications like scheduling and telephone directories; an ePocrates drug database; a clinical suite that ties into the hospital information system for patient records, laboratory reports and imaging reports; and an educational component that includes class scheduling and lecture material.
Phil Skinner, enterprise services director at OSU Medical Center, says the hospital's wireless computer network runs through all clinical care areas. It is linked to a Siemens EMR system and AGFA digital imaging equipment. Anesthesiologists frequently connect remotely to operating rooms to guide residents through surgeries.
Still, he estimates only 10% to 15% of attending physicians use PDAs in clinical settings. One thing OSU is missing is real-time PDA networking, save for the few users with cellular modems. Most of the 1,000 or so current PDA users must "sync" their handhelds at infrared transmitters at nursing stations or on cradles stationed throughout the hospital complex.
"Palms, up until this past year, had not been quite ready for noncellular wireless," Thomas says. The medical school does plan on going to live, wireless access within about two years.