The pulse of health care is wireless: The future medical enterprise

According to a recent American Hospital Association survey of the 100 "Most Wired" Hospitals in America, the top innovations include interactive self-assessment tools, education Web sites, monitors that send readings right into patient medical records, and devices that let X-rays and other medical images be viewed from anywhere. What underlying technology is making such innovation possible? Mobile and wireless technology, combining the Wi-Fi network with care-critical applications and content.

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According to a recent American Hospital Association survey of the 100 "Most Wired" Hospitals in America, the top innovations include interactive self-assessment tools, education Web sites, monitors that send readings right into patient medical records, and devices that let X-rays and other medical images be viewed from anywhere. What underlying technology is making such innovation possible? Mobile and wireless technology, combining...

the Wi-Fi network with care-critical applications and content.

This is driven home in this soon-to-be common scenario: patient Jane Doe enters a hospital and is registered via a laptop. A nurse with a handheld personal digital assistant (PDA) device does an initial patient information check at bedside. Jane is connected with sensors to monitor body functions that are wirelessly connected to the hospital network. Doctors in the hospital, at other hospitals, or at home can analyze the data. The doctor uses his PDA to order tests and X-rays, then investigates drug types, interactions, and then e-prescribes the drugs to Jane. The X-rays are sent over the wireless patient information system to the radiology department and viewed on computer screens. Jane later goes into surgery, where every item in the operating room is bar-coded and scanned when used. New items are immediately ordered in a computerized inventory system. Jane is later discharged with sensors that can continue to monitor her at home and relay the data wirelessly back to the hospital. The result: better, faster health care at reduced cost, helping patient, doctor and hospital.

With such results, the mobile and wireless trend is only growing. Two in four doctors use personal digital assistants (PDAs), according to Forrester Research. And in a survey by the Health care Information and Management Systems Society, half of all hospitals say wireless devices will be the top emerging technology they would deploy within the next two years.

Benefits of the integrated mobile health care enterprise

The explosion in wireless and mobile technology is happening because it helps doctors do their job better. Mobile medical technologies, when integrated with the health care enterprise IT infrastructure, support medical professionals by enabling them to think through complex decision making processes, refer to vast stores of relevant information that are critical to decision making at the point-of-care, make informed decisions and act on them by conducting transactions right from the device. Mobile medical technology improves both the quality of their professional work as well as their efficiency in handling administrative overhead.

Among the benefits of an integrated health care enterprise with a mobile technology platform are:

  • Safer, faster health care. With the information available over wireless networks for doctors on call, they can make more informed decisions when paged by a patient or handling referrals from another health care worker (i.e. other nurse, home health care, family member, physicians in training, etc.)
  • More effective charge capture. A critical practice in hospital and ambulatory care settings. The results: can justify level 4 /5 billing without risk of fraud and can submit charges electronically so that the adjudication process is quicker. It can also reduce number of ancillary FTE's required to handle billing process.
  • Reduced lag time and LOS. PDA's with telephony or voice-over-Internet-protocol (VOIP) applications can reduce amount of lag time between nurse-to-physician or physician-to-physician communication. It can reduce the contact lag time from an average of 20 minutes to one minute.
  • Fewer medical errors. Cost saving increases. e-Prescribing – computerized physician order entry integrated with electronic formularies and drug references (this includes ambulatory outpatient care as well) -- can reduce formulary errors (i.e. interaction checking, allergy checking, appropriate name / dose, etc.) which result in better outcome for patients. This also leads to increased formulary compliance, which saves hospitals and PBMs money, saves money for patients with smaller co-pays, and reduces medical errors -- an enormous cost to hospitals.
  • Better knowledge -- Better care. The gold-standard knowledge resources provided via PDAs means more evidence based practice. This is an obvious case for improved safety. It can also result in more judicious use of diagnostic modalities and therapies (rather than the "do it all" approach.) as well as provide the best standards for care.
  • Improved enterprise workflow. From an enterprise perspective, hospitals and other organizations can use an integrated mobile platform to disseminate important information, such as best practices and hospital guidelines to all employees with PDAs. This will reduce costs and streamline hospital operations and help ensure all activities are done in accordance with procedures.
The mobile technology trend is being fully encouraged for medical practitioners in training. Today more than 20 percent of residency programs in the United States require their residents to use PDAs. Many provide their residents with a stipend with which to purchase software and tools for the PDAs. The University of Louisville School of Medicine gave 900 PDAs loaded with software and applications to support the classroom learning and clinical work of health sciences students.

One approach -- The mobile platform

Deploying a mobile platform as a foundation for a hospital's systems architecture is one approach to help hospitals quickly realize benefits of a new class of enterprise applications for mobile devices. The mobile platform can be tied into enterprise applications, capturing this information, and presenting it on the mobile device.

This mobile platform would provide support for the integration of information from multiple sources into highly organized information structures that are very efficient for decision-making. By integrating both transaction and content under one representational enterprise mobile platform, it empowers medical practitioners with a highly efficient cognitive process -- thinking, referring and acting.

Take for example Dr. Sameer Bade at Brigham & Women's Hospital in Boston, who uses PDA technology for e-prescriptions. Bade says that the integration of an e-prescription writer with a drug guide and a drug interaction reference provides medical practitioners with a solution that is much more powerful than the sum of its parts. This, says Dr. Bade, enables the doctor, when needing more information about a prescription being written, to instantly launch into a drug guide to validate dosing and then if needed into a drug interaction reference to verify an interaction question. This is done quickly and easily, right at the time when the information is needed and without changing the thought process the practitioner is accustomed to. Integration of other third party applications with existing hospital technology is easy because of enterprise mobile platform is designed for such integration.

Dr. Eugene Bailey from SUNY Upstate Medical University believes that a new breed of handheld computers, or personal digital assistants (PDA), are revolutionizing emergency medical response health care. Between his patient care and teaching, says Dr. Bailey, "I use my PDA upwards of two dozen times per day for a variety of uses -- to teach students and residents, diagnose illnesses, determine treatment, prescribe medication, determine drug interactions, calculate dosages, and perform all necessary steps involved with quality patient care regardless of location."

A mobile platform that supports multiple channels of information enables the practitioner to dynamically access information on late breaking news such as drug and disease alerts, as well as frequently available information such as drug weeklies and journal subscriptions. For the best access, all the channels would be organized hierarchically allowing for easy navigation and review of current information, and the channels can carry many types of content which links together in context providing the best experience and fastest access to critical decision-making information.

Access to intelligent mobile channels keeps doctors and nurses on the pulse of medical technology/health care. Each channel derives information from a different source such as printed material including well-known newsletters or journals, databases, web or custom content. For instance, one channel may provide information on the latest information on SARS from the CDC website, another might provide drug alerts from the FDA, while yet another channel may deliver the monthly content from a specialty journal. The power and benefit comes when channels are integrated.

Time shavings equals hospital savings -- ROI of the integrated mobile platform

PDAs integrated with hospital information systems via the mobile platform provide physicians and nurses with instant access to information and data that can save hospitals time and money while providing better care. Physicians surveyed responded with an overwhelming 88% 'yes' that they are able to provide better care in less time by using a PDA and 76% responded that they believe PDA use reduces medical errors by more than 1%. Some examples of return-on-investment on a per task basis:

  • Instant access to detailed clinical information and drug databases -- saves 5 - 20 minutes with possible critical care impact and error reduction.
  • Instant access to FDA updates linked to the drug being prescribing -- saves 5 minutes and creates improved prescribing, fewer calls from the pharmacy and most importantly reduces prescription errors.
  • Ability to prescribe & give orders right from the PDA -- saves 5 - 10 minutes and results in fewer errors and fewer calls from pharmacies.
  • Instant access to dosages -- saves 5 minutes and results in fewer errors.
  • Ability to enter diagnosis, ICD-9 and procedure codes in HIS -- saves 10+ minutes and provides fewer errors, fewer billing follow ups and faster payment.
  • Instant access to patient history -- saves 15 minutes and provides more quality time with patient and time to visit others.
Handheld devices are the tools, but it is the software solutions that will provide the answer to better health care. Extending from the individual practitioner to communities of mobile professionals working collaboratively, transacting, and referring, the PDA today is connecting medicine throughout the health care enterprise. These high-value professional communities will greatly benefit from even more dynamic information access at their fingertips that will improve both the quality of care as well as their efficiency in handling the administrative overhead that is part of today's rapidly changing business environment. Additionally with Electronic Medical Records (EMR), Clinical and Drug References, Patient Management Systems (PMS), Patient Scheduling Systems, e-Prescription writers, and other enterprise functionality being more widely available, mobile technology will play an integral part in providing the complete decision-making solution practitioners need to practice the best medicine.

About the author: Sandeep Shah is founder and CEO of Skyscape, a provider of mobile medical solutions in Hudson, Mass. For more information, visit www.skyscape.com.

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