American College of Physicians: Internal Medicine — Doctors for Adults ®

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When hospital mainframes meet physicians' PDAs

From the April ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

When patients of Howard Steiner, MD, ask him about their test results, he doesn't have to run to a terminal or wait for an orderly to deliver the news. Instead, he just looks in the palm of his hand.

"I can get all my patients' information-labs, X-rays, pathology, medicines and vital signs-from my palmtop," said Dr. Steiner, who works in the pulmonary and critical care unit of Good Samaritan Hospital in Baltimore. "If a patient asks how his potassium level is today, I can rattle it off."

A growing number of hospitals like Good Samaritan are entering the next phase of handheld computing and connecting their mainframe computers to physicians' palmtop computers. The goal is to give physicians the patient care information they need at their fingertips.

Good Samaritan began the project by conducting a study to compare a palmtop patient sign-out system with hand-written sign-outs. The study found that sign-outs created on personal digital assistants (PDAs) were more complete because the computers prompted doctors to include information they otherwise tended to forget.

According to John Hong, MD, who helped connect the hospital's systems to PDAs, the handheld-based sign-out system proved unwieldy and redundant. The big problem? Doctors needed to enter too much data into their handhelds that the hospital information system already held. Hospital officials quickly realized they needed to develop an interface that would allow handhelds to access data directly from the hospital mainframe.

Today, physicians use their handhelds not just for patient sign-outs, but as portable computer terminals. More than 100 doctors use a feature known as Clinical Summary that allows them to connect their PDAs to a network computer and download information from the hospital's data system.

When blood work is completed and available on the hospital network, for example, physicians can view those results the next time they connect their PDA to the network. According to Dr. Hong, who is director of Good Samaritan's internal medicine residency program, such quick access to information makes physicians more efficient and less likely to order redundant or unnecessary tests.

Good Samaritan has constantly added functionality to the system. The hospital recently created a wireless interface that allows physicians to tap into the main systems without ever connecting their palmtop to another computer. Instead, physicians can connect their PDA to the hospital system wirelessly, much like they would make a telephone call using a cell phone.

"The program I use saves time running to the terminals," said Jeremy Weiner, MD, a surgeon who uses the system. That's an important feature, he noted, because those terminals are often jammed with nurses.

Besides patient information, the Good Samaritan system also gives physicians downloadable medical references and diagnosis and procedure billing codes. It also has a charge-capture function that allows doctors to record their interactions with patients more accurately. Hospital officials say this feature leads to more precise billing, fewer rejected claims and more revenue.

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