Arriving for their early morning shifts at Houston's Northeast Medical Center, the first thing many physicians do is wirelessly sync their Treo smartphones from Sunnyvale, Calif.-based Palm Inc. An application called PatientKeeper Clinical Results from Newton, Mass.-based PatientKeeper pulls data from the hospital's QuadraMed Affinity health information system to show a patient census, as well as lab and X-ray results — with abnormal results highlighted. Doctors at the 243-bed facility can even graph the results over the last several days to show trend lines, and soon they'll be adding vital signs such as temperature and blood pressure.
Carla Maslakowski, Northeast's vice president of operations, says a big selling point for physicians is sharing the results with patients. "They'll say, 'You know that CT scan you had this morning? Here are the results.' And they look at the handheld together."
Northeast plans to implement PatientKeeper's charge capture module, Maslakowski adds, which will let doctors use their Treos to enter charges for services.
Everywhere you look
Personal digital assistants and smartphones have become so ubiquitous in hospitals and clinics that most experts say it's not a question of whether they'll continue to be used by clinicians and supported by IT departments, but to what extent.
Some argue that handheld devices will play an increasingly transactional role, with clinicians using it for billing, e-prescribing and entering clinical notes. Others argue that its small screen size will leave the PDA as a valuable but limited reference tool. But regardless of the level of integration eventually achieved, the physicians themselves have become the handhelds' greatest advocates.
"This is one instance where the clinicians are pulling IT, rather than the reverse," says Mohammad Al-Ubaydli, M.D., author of "The Doctor's PDA and Smartphone Handbook."
Michelle Snyder, vice president of marketing for San Mateo, Calif.-based Epocrates, publisher of a PDA-friendly drug reference guide, agrees. "We think PDA use is so widespread exactly because it was more of a grassroots movement. The push for adoption wasn't coming from the top down."
Many clinicians are hungry for drug reference tools, continuing medical education, and access to patient data from their handheld. "This is where the institutions need to support the clinicians a little more," says Al-Ubaydli, who leads a Washington, D.C.-based health IT consultancy called The Advisory Board Co. "Most are planning for EMR software. The next stage is for them to integrate the EMR with the PDA. That is not very common yet."
Physician use of PDAs has more than doubled between 2001 and 2006, according to surveys of 1,200 practicing physicians by New York-based Manhattan Research. "Our research shows it continuing to increase with just less than 50 percent of physicians using them now," says Erika Fishman, senior analyst. The number one use is for a drug reference database, followed by prescription dosage calculators, continuing medical education and product updates.
"There's still a very low percentage using it for advanced activities such as e-prescribing or looking at imaging or an EMR," she says. "For those, they are still moving to a PC."
The faster the better
Handhelds appeal to doctors mainly because of their speed, says Paul Auwaerter, M.D., chief medical officer at the Johns Hopkins University Point of Care Information Technology Center, which publishes the ABX Guide, a clinical support tool widely used on PDAs.
In his own practice, Auwaerter says, he uses a handheld because it's faster than finding a workstation and logging on. But he doubts handhelds will become the physicians' main computer interface. "The screens are too small to easily view lots of data," he says. "Physicians want to jump in and out in 30 seconds. If you have to read notes or scroll through labs, it becomes too cumbersome."
General practitioners and specialists alike are finding handhelds increasingly valuable as more applications are tailored to their specific needs.
The American College of Cardiology (ACC) has teamed up with Epocrates to offer a set of tools designed specifically for cardiologists, including CardioMath, a suite of 50 commonly used formulas in cardiovascular medicine.
Washington, D.C.-based ACC is shifting its continuing medical education to be accessible from PDAs. "Physicians cannot be tethered to a workstation," says Brad Ettinger, ACC's senior director of e-business and digital products. Among ACC's membership, more than 80 percent of the younger physicians are using mobile devices. This is driven in part by the fact that about 35 percent of medical schools are now requiring the use of a PDA in the third and fourth year.
Ettinger says that handhelds' impact on cardiologists has been "pretty startling," adding that the instant support they provide is invaluable. "If a patient tells a doctor they're taking four drugs and feeling dizzy," he adds, "the doctor doesn't have to say, 'I'll go look that up in my office and get back to you later.' They can look up contraindications right on the spot."
David Raths is a contributing writer based in Philadelphia.
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