At the Indiana University School of Medicine (IUSM) in Indianapolis, physicians are more likely to be associated with their personal digital assistants (PDAs) than with lab coats and black bags crammed with reference books. For the past two years the medical school, acting on the recommendations of IUSM's Educational Technology unit, has made handheld devices as integral to med students' clinical education as stethoscopes.
Recently, the Liaison Committee on Medical Education (LCME) established a mandate that all medical schools must collect outcome data to demonstrate the extent to which its educational objectives are being met. Collecting this data from all students presents a significant data-collection challenge. As we grappled with satisfying the mandate, we realized the potential benefits of adopting a school-wide PDA-based data-collection system.
By investing in a standardized platform, we had an opportunity to rescue the university from the increasing financial and operational burdens of a paper-based system of data collection, storage entry and reporting. A streamlined data-scapture process is beneficial to the school because the information collected is of critical importance to the school's continued accreditation.
IUSM, the second largest medical school in the country with nine campuses throughout the state and an enrollment of 1,200 students, recognized the opportunity and began a comprehensive program to educate its students and faculty on the benefits of using mobile technology. Through the department of Educational Technology, the school took action to make sure that new initiatives were being incorporated into the medical curriculum. In 2002, our Educational Technology unit began introducing faculty and students to PDAs through the use of periodic exhibitions and lunch-and-learn sessions. Later, in 2004, based on the LCME mandate, our PDA program segued into the centerpiece for our Clinical Encounters Real-Time Tracking System (CERTTS).
In addition to providing our students with mobility and a faster, more reliable way to record clinical encounters throughout their required third- and fourth-year clinical rotations, we also wanted to grant them rapid access to vital reference materials. By supplying future clinicians with treatment information at the point of care, we facilitate learning opportunities. Our desired project outcomes — for students and the educational system — included faster access to clinical information, fewer data collection errors, reduced likelihood of lost data and a centralized collection and reporting process. In addition, IUSM hopes to foster ideas for solving problems that future healthcare professionals will face as the need for accurate clinical and research information continues to grow.
For security — a top concern for all medical school IT departments — the system encrypts the transfer of data. The student log data focuses on clinical experiences or encounters and does not contain identifiable patient data. However, as a precaution, our system has been reviewed in light of HIPAA concerns and approved by our internal Compliance Office.
In the latter half of 2003, we initiated a campaign on campus centered on the potential for IT solutions to satisfy LCME mandates while simultaneously investigating various hardware and software products. Based on our research, in 2004 the administration of IUSM established a requirement that all upcoming third-year medical students purchase a PDA. To maximize interoperability between the school and medical center and to minimize training, we decided to standardize students on the Palm operating system using Pendragon Forms Enterprise (Pendragon Software Corporation of Libertyville, Ill.) as the framework for collecting data. The most important criterion used to make this choice was the need to collect signatures from doctors, nurses and residents to verify the students' clinical experience. An internal review was done in early 2004 to determine what type of system could satisfy this need.
At the time, Pendragon Forms was the only vendor we found that offered a practical way to electronically collect a signature that could be rendered as an image for viewing on the Web. In December of 2006, IUSM again reviewed the available technology. At this point, two other systems were determined as feasible — digital pens and OMR (Optical Mark Recognition) scanning. After obtaining vendor quotes, digital pens were over the budget allowed for the project. OMR scanning was viable, but required a return to paper. Logistically, the dissemination of paper forms was too difficult to manage for students as they rotate through clinics, hospitals and private offices statewide during their third year of medical school.
In early 2004, Educational Technology assumed the challenge of converting IUSM's paper forms to a digital system. When the system launched in June only a “raw” view of captured data was available. Clerkship directors could look at an individual student and see a list of clinical encounters in table form. After being exposed to these Web-based reports, directors were able to formulate ideas about what criteria would be used to evaluate student performance. In order to make custom reports available on the system, we met with each of nine clerkship directors and considered the specific needs of each.