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Digital Doctoring
ssajous writes "This is an interesting article in the NY times which talks about PDAs quickly finding their place in the world of medical billing and keeping track of patient's care, there is a lot of money in the medical field, but also currently a lot of unnecessary paper work. I like what I see!!!" I don't think Palm makes a tricorder card yet, but it's only a matter of time. The last time I saw a doctor, he was doing things the old-fashioned way - I would guess it will take a while before this sort of technology is widely used.
believe it or not the Newton had made a lot of inroads into this before Steve killed it. A lot of the apps for the Newton were specifically medical/hospital.
When you're sitting there, in a cold doctor's office, with only a sheet over you, and nothing but drug literature to read, it's great to be able to pull out a Palm and play a little Freecell, or even tweak a few web pages.
Security concerns aside, this is a really great idea because it allows multiple people to at least read a record (i believe they have a check-out mechanism to prevent more than one person from writing to the chart at a time).
Of course, there's the ambulance chasers, who whip out their PDAs and start taking names for litigation. However, the PDA is the number 2 favorite of the ambulance chaser; number 1 is the instantly inflating balloon for putting under women's shirts to feign the third trimester.
"Ancillary does not mean you get to rule the world." --U.S. Circuit Judge Harry Edwards, speaking to the FCC's lawyer
Maybe when they have good voice recognition for the Palm, then it might really look like a sexy alternative to pad and pen. But not yet.
I worked in the Medical Software business and let me tell you it is SCAREY. I worked for one of the largest medical software companies in the USA who claimed to be "modern". However, they were still coding in COBOL 74 (that is GOTO logic for those who don't know). I soon realized I had to get out of there. You would be amazed at how screwed up Medical Software/Hardware really is.....
my brother is a doctor and he uses his Visor regularly. Mostly it helps him explain to people whats wrong, without having to get out a big text book and show them the pictures. he loves it.
There are a number of problems with the concept of digital assistants in medicine. I worked in the field for some time and ran into all of them...
o Resistance
But I've *always* done it this way
o Portability
How do you move from patient to patient and
get data into a centralized database reliably?
o Reliability & Security
Medical data must be valid, authenticated, and
readily available. Having a system crash when
you're evaluating someone's heart condition is
unacceptable.
o Legal considerations
Doctors' notes are considered as legal
documents when looking at medical malpractice
and other legal-medical collisions. How do you
verify that the electronic format is the same
as the paper one when there *is* no paper one?
There are more, of course, but these are the big ones I ran into time and again. The bottom line is that while Hippocrates and other PDA software packages are useful, the likelihood of the medical profession accepting the widespread use of portable technology for medical data entry and retrieval is slim anytime soon.
...a good idea. The Palm and Palm-based PDAs could definitely speed up things. One thing that comes to mind is insurance adjusters. They could bring out their PDA, take in all the information they need, hook it to a laptop and have everything done in a fraction of the time. PDAs are going to gain a wide use. I know I use my Visor a ton.
-=-=-=-=-=-=-
The COBOL Warrior
-=-=-=-=-=-=-
The COBOL Warrior
"COBOL's Not dead, it's just underground"
Do the PDAs need some sort of jacket to prevent them from gathering/transferring germs/deseases in cracks and crevices? What do health regulations say about electronic equipment in hospitals? Does each electronic product have to be certified or something by a governing body as safe for use in a medical facility?
To a new everything, so that now there is a complete PC (Windows) in every office that brings up your history, the works...and even sends prescriptions over to the pharmacy for pickup. Of course, when they implemented it at first there were tremendous problems (like 3 hour lines for drugs) but they seem to have worked it out now. I'm just afraid that I'm going to go in there for something serious one day and his machine is going to crash in the middle of something important, thus giving Blue Screen of Death a whole new meaning. (Ok, I bet I'm not the first one to say that. :))
www.HearMySoulSpeak.com
My wife's OB was using a Palm over three years ago to keep track of his rounds, set up followup visits, and keep brief notes on his patients. He was the first in the office to try it out, but even then he'd been getting a lot of (positive) comments from the other Dr's in the practice.
The books published by Franklin for all the hand top OSs. It's just that the hot swap HandSprings allow people to carry several around.
A small piece not mentioned in a good article.
Profit motivates invention.
Well, here in Israel all the doctors in the clinics use computers, but desktops, I think using a palm would be an improvement for them. It's portable, and has a touch screen which is much more comfortable for immediate use.
where I work for the IT dept. PDA's have become a favorite for doctors and marketing. Altho it still seems like it's more of a statis symbol than anything else. It's the next best thing to a laptop, which is another statis symbol amung the Dr's. Plenty of laptops at the hospital never leave their docking stations. But PDA`s on the otherhand.. those are in just about everywhere.
__________________________________
Free your mind - Flush your toilet
Many doctors and nurses are beginning to use Palms and specialized software to handle patient information, take notes, and do quick research on different medicines (there is a pharmaceutical references Visor module). What's more, I've seen a lot of use of the wireless Palms as well.
For the most part, this is great. However, my biggest concern is the base infrastructure - these PDA's tend to interface with grossly outdated software.
--
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Welcome to the land of the easily amused...
the only cell modem in it is the one mandated by the NSA.
The reason why they won't allow things like this in a hospital is because of strict rules regarding such items. For instance have you ever noticed that when you go into a hospital they ask you to turn off cell phones, beepers, any tiny gadgets etc? Its for the well being of the patient its also so that none of their equipment malfunctions while performing operations. Hospitals are a sensitive area because when the EKG starts flat lining but the person is still alive and it was all because of your cell phone, it'd have a very adverse affect on the hospital itself and the dead patients which they could charge you with homicide for; knowing or not.
Yes it would be nice to have things and organizers like these in HMO's and other places but not in a hospital. I'm sure you wouldn't like it if you knew that a loved one died because some person had to know when his/her next meeting was going to be.
My friend is a doctor in large hospital in NYC, and she uses her Palm all the time. It has replaced a least a half dozen heavy manuals she used to keep in her pockets. Many companies now sell e-text versions of their reference works. She got it to reduce the number of reference works she had to use, but I think it is better in that it facilitates better searching and indexing. She is young, and young doctors liker her use them all the time, it is the older ones in power that are technologically resistant.
I think that it is unfortunate the medical field has been so slow to adopt technology like this. If anyone knows the history of MYCIN, it is amazing to me that the medical field has ignored such powerful diagonostic tools. In the end I think it is the public that suffers.
"Politics is for the moment, an equation lasts eternity" -A. Einstein
Here
/. doesn't just use these instead of the "please sign in or register" links.
Personally, I don't see why
I havnt seen a need for PDAs in my own life. They have always been neat little toys as far as my life was concerned. Some people really need them, but I think for the most part, they are status symbols and/or toys. My thinking changed after I saw my brother in law's Visor at Christmas. He is a medical doctor and he had a great database stored in his PDA. He had diseases and different conditions loaded in the prepackaged database that he could update as well. It seemed as if he found it very useful at work. Reading about Doctors and PDAs just reminded my of this minor enlightenment of my own.
My MD has one of the early Palms and has been very interested in my Visor every time we meet. Last time he told me one of the pharmacutical reps was offering him a brand new color Visor just as soon as they can get them. Seems they figure its a good way to get more branded info infront of the MD and get on their good side - so they write perscriptions for the Real Stuff not some cheap Generic Equiv.
My doc wasnt too keen on taking it, since he already has one and doesnt use it a whole lot (office, billing, schedule not tied in, etc.) But since its free he might just take one for each of the MDs in his group.
The PDR on springboard looks pretty interesting!
Anyway, he was one of the first people in Lewiston to buy a PDA, and he's still got one now (Handspring 8MB model). He carries it everywhere with him, keeps all of his stuff in it, and uses it for everything. And oddly enough, this has become typical in that hospital. If there's a market to be had for PDAs, it's probably indeed with anyone who collects data - and doctors fit snugly into that category.
CAP THAT KARMA!
Moderators: -1, nested, oldest first!
SIG: HUP
Here's the challenge..
What do you think we will see in our lifetime, and which will be more difficult to code for:
1. Reliable, 99.99% rock-solid voice recognition? 2. Artificial Intelligence 3. Slashdot being bought by Microsoft 4. Larry Ellison, Bill Gates and Richard Stallman joining a wife-swapping group. 5. Handwriting recognician software that can actually read a doctor's handwriting? (Have any of you actually seen a readable prescription in your life?)
My vote goes to the first four as most likely.
But as a software platform, I think they are not all that good. They have megabytes of memory now, but they suffer from 64k limits somewhat analogous to what DOS used to impose on programs. And while PalmOS is conducive to letting experienced PalmOS programmers write tight, simple applications in C, for many custom applications, you want something like Java, Smalltalk, or even VisualBasic.
Palm has made steps to offer Java and to upgrade the processor and OS. Let's hope those will happen soon.
"He's in convulsions from waiting too long in the emergency room! Quickly, beam me Pimp Wars, STAT! C'mon... we can get through this..."
My sis uses her Visor for some real med progs, too. Drug interaction lists are a lot easier to carry on PDA than the binders (constant updates) it otherwise requires.
I've learned about this first-hand: Last year, My wife was diagnosed with Type II diabetes in the aftermath of a failed pregnancy.
People diagnosed with Type II diabetes often have to test their blood seven (7!) times a day (or more!) in the first few years, and record the results, time/date, and diet info for their doctors. Manually, this can be a pain in the ass, especially when full records for 2 months need to be given to a doctor.
Right after being diagnosed, my wife found out about Glucopilot (see http://www.healthetech.com/), an award-winning program for the palm OS, which prompted her to buy a Palm V and a hard case. It does a wonderful job of recording, handling, and outputting & graphing the data. With the purchase of a small cable (made one myself, ha!) it can read the output of some blood sugar testers directly and eliminate the manual entry of numbers all together.
Her doctors, both of whom where unfamiliar with the program, were astounded by it and the detailed data it provided when she show it to them, and they began mentioning it to their other patients.
It's not just the Glucopilot software though, My wife found several other programs for the Palm that she uses to track diet, and other medical info like details on her menstral cycle, sudden sickenesses, and anything else.
Where this really makes the impact is on the day-to-day lifestyle front. She has a tiny case that she carries with her eveywhere she goes because it is so compact and totable. It holds her Palm V, and her blood testing gear. Because the form factor is so friendly, and the software provides such immediate feedback on blood-level trends, etc, she has displayed incredible dicipline in taking readings and entering data as it occurs. And that dicipline has seriously impressed me and her doctors, and is probably why they are saying she will be able to control the condition without needing insulin shots, etc.
The palm has been great for collecting all my loose data in one place, and I see specialized, easy-to-use medical tracking and info software as providing great benefit to people who have problems that are ongoing and have to shared with their doctors.
The Healthy Palm
and others...
Thing is, though, I'm not sure I'd trust, for example, a pregnancy-safe drug list I just got off some guy's home page...
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What's interesting is the amount of medical students snatching up palms in preparation for entering rotations. My wife is currently a second year medical student about to enter rotations this summer and she along with many of her classmates are buying some sort of palm device specifically for their rotations. There are a slew of databases containing drug information, disease/symptom data, etc. There are apps for patient tracking. It will be interesting to see how long it takes hospitals and clinics to incorporate new procedures utilizing palms into their existing procedures. I'm skeptical about the rate at which hospitals will adopt said procedures. It's been my experience w/ large academic hospitals (which are usually the most eager to try new technologies) that it's very difficult to get the physicians to adopt new procedures. Palm based procedures may appeal to the new generation of doctors but there are a lot of stubborn older physicians that are set in their ways.
Many of the current meters have the ability to download the readings. My First Step records 50 readings internally and keeps date and time information and even logs averages and trends. Upload to the PC once a week and send in.
One of our developers is currently working on implementing a ticketing system for us peons (admins) to use. The idea is, we'll carry around the palm pilots, when there's a call, we input the ticketing info into the pilot -- we then sync up with the server twice a day. Personally, I'd rather not have these things. I already look like Dilbert...the last thing I need is another gadget. (As it is, I don't use paper).
g
I work in a large hospital, in the ER, and currently we are trying to phase in handheld, and small 'touch-screen' patient-charts, called 'echarts.'The problem lies not in the fact that they're bulky, that they use a pseudo-windows UI, and that they use stubborn LCD displays. It probably has nothing to do with the fact that their login is the last name and the first initial of any employee. Most likely nobody knows that they communicate via RF so that they can connect to the network. I doubt they remember when the backup power generator turned on, and scrambled that RF connection. The REAL reason that nobody wants to use them is because they're different,bulky,and difficult if not downright impossible to navigate. At least the paper forms are color-coded, and all look pretty, with the cute nurses' curly little handwriting. These chunky boxes look cinder-blocks wrapped in rubbery plastic. I'd bet that when someone comes up with a more ergonomic, eye-pleasing design, the doctors, nurses, and techs will be more willing to convert to the Paperless Way. But for now, the things sit in the corner, collecting dust along with the dot-matrix printers, almost totally unused. Not until these devices are used from the beginning, i.e. in the nursing and medical schools, will doctors et al be willing to trust life-or-death info to them!
The big clinic that my kids' pediatrician works in has laptops with wireless LAN posted throughout the clinic. As soon as the doctor completes the exam, he inputs the data directly. Not quite a PDA, but a pretty slick paperless setup nonetheless, and of course, it's all tied into the clinic's centralized databases and apps.
I assume they use laptops so that they can more easily be swapped out for maintenance, repairs, etc. And the wireless LAN simplifies a lot of networking issues, I'm sure.
After I got my m100, I was lookign at memory upgrades. One of the sites I found is by an MD.
For that matter, are there any PDAs that work with the current 802.11b standard for PC base stations?
- I don't care if they globalize against free speech. All my best free thoughts are done in my head.
You might think this is stupid, but there is a reason why they use old technology: it's tried and true. When your rinky-dink website crashes because of a minor bug in the software, that's annoying. When the ICU-1 server crashes, patients die - no joke. We had to operate at < 1 min. unscheduled downtime per month, or we were replaced.
So the palm thing is cool, but don't expect doctors carrying around PDAs to diagnose for quite some time - at least, not in any official policy. On the other hand, my dad is a doctor, and he now has a drug database on his palm, as well as a diagnosis kit, and he loves them both ;)
I worked on a project a few years ago to integrate the Palm into the routines of doctors at a major university hospital. The project started out by allowing doctors to access an online database to lookup test codes when ordering a test for a patient. This was done by setting up a web clipping applet on a PalmVII and changing the previous webpage a bit. The project was a success despite the fact that some docs preferred the 'old way'.
The next phase of the project was to allow the doctors to access patient records via the palm. This of course would require a 'key' in the palm that would allow only that unique palm on top of authentication to the server to have access. It would then be tested with a fake patient database and evaluated. It would then go in front of a board to determine the security and applicability of the process and whether a 'live' test group be started.
At that time (1999) many doctors were very apprehensive about using this, I hope things have changed by now..
First. It needs to be transparent. If a Doc has to hotsync before each patient, the palm will live in it's cradle... never used.. it must be wireless.
Second. Easy to use. Doctors have the worst handwriting on the planet. either they are just plain lazy or have no handwriting skills, but it is universal... doctors can't write. so you expect them to use hand writing recognition system like on the palm?? not likely. Until the doctors are forced to write legibly (as in prescriptions too!) they will not comply.
Third.. Price. Doctors are usually cheap. They will not pay $500.00 per wireless palm and $900.00 for the wireless portal and then $20,000.00 for the software. they will stick with the antique foxbase based dos-text medical system on netware 3.x forever. Why? because what is available out there sucks (ALL medical practice software is a messy joke that can barely be called software. and the Windows based stuff is a collection of bugs at best) and is insanely overpriced.. ($3500.00 per workstation license fees for a program that fits on a floppy and was written in the 80's? bite me buddy!)
The medical field is plagued with many problems.. the first is crappy systems and software that scare the doctors. if we get rid of the crap and start charging sane prices.... maybe the doctors will start looking at it.
Do not look at laser with remaining good eye.
I come from Springfield, MO, a major medical town for the area where many doctors now employ palm devices to track complicated lists of patients, numbers for pharmacies, and other information. This IS a step forward in medical technology, using something that doctors can carry around and track patient lists, but many times these PDAs are not in the hospital "network", and do not exchange information, such as patient status or call schedules. But of course, this is a large leap in technology, and the medical industry needs something to be more efficient with the ever lowered spending with medicare and the HMOs. Perhaps this technology, when used correctly, can improve productivity, but for now, it is limited to being something for personal use by many doctors.
A lot of people in ER's, especially the nurses, are using PDA's to keep track of patients. One person I know uses a little palm app to quickly jot down all the incoming patients for triage, and then hotsyncs to her computer to produce initial patient records. She then keeps track of who is where the same way.
If you add on wireless connectivity and a durable piece of hardware (ie, spillproof, drop-proff), PDA's in ER's would work really well for everyone (no more paper charts till they leave!)
-MR
-Michael Roy Some people are like Slinkies. Not really useful, but you can't help smiling when you see one tumble down
o Portability - use Symbol 802.11 enabled Palm and have spread spectrum radio coverage throughout and either a telnet or html client.
o Reliability & Security - NEVER USE MICROSOFT!!! Use AS/400 if you want absolute reliability, or Unix if you want high reliability with ease/cheapness of coding/updating.
o Legal considerations - there are many ways to sign/legally encode a file...discussed elsewhere.
This only leaves the "We've always done it this way" brigade - work on them:)
Frog51
Electronic devices per se are fine in hospitals, and I tend to spend a lot of my time setting up rf networks in hospitals (802.11 kit in UK is limited to 100mW output power) with no problems - in fact we often hook heart monitors to mobile bridges so patients can be moved without having to take a trolleyload of hardware with them, or drug trolleys with a laptop and rf network card to make patient record updates easier and more accurate. Its devices with the output power of mobile phones (1/2 a watt and up) which can interfere with sensitive heart monitors.
Although I have seen a Vodafone antenna siuated on the top of the Royal Infirmary in Edinburgh!!?!
Frog51
We've done a lot of consultation with hospital staff in the improvement of quality of care, including bring staff up to par on standards of care for different problems. What I've seen is pretty scary. While overall care is ok, many many times standards are missed which results in increased patient suffering and longer hospital stays.
Consistent use of handheld computers could very easily improve the care that patients recieve across many settings. For example, the Doc checks off Diabetic and gets a list of recommendations like running certain tests, foot exams, and setting up outside education and consultation, which could also be suggested contingent on certain criteria.
Personally, I'd feel much better if my Doc relied on a standard reference in treating me. Doctors are not all super-intelligent and many have lots of trouble remembering important information, particularly for less common ailments.
Long ago, before Jobs canned it, one of the classic Newton markets was the vertical/health market. Lots of software companies offered software to doctors catering from patient tracking, medical records to digital books on procedures, information and diagnosis. Most of those companies switched to Palm as soon as Apple closed Newton Inc.
All in all is good to see the technology and uses getting some public recognition.
I hate to agree with davecrazy but...
I'm currently involved in the development of tools which clinicians can use to find the relevant recommendations contained in a clinical practice guideline, given a particular 'case' (patient characterists, availability of resources, etc.). This kind of project is much more involved, and more complicated, than a reference app -- the kind of thing that tells you which drugs interact with which other drugs -- but it is potentially much more useful.
It's important, I think, to talk about the real potential, and the real danger, of this kind of automation...
Automating the delivery of recommendations from medical Guidelines improves the quality of care because physicians are often too busy to consult lenthy, complicated print guidelines. Having them in electronic format alone isn't much help -- these systems have to pull patient characterists from existing medical record systems and offer recommendations based on those variables. In other words, they have to be able to step through a series of logical statements and offer an evaluation to the physician. This will, in the long run, greatly improve patient care, because decisions will more often be based on empirical evidence rather than on convention or tradition.
The danger is NOT that physicians will blindly follow recommendations (any good system should offer a natural language explanation of how it arrived at a recommendation, which the physician can then accept or reject), but that HMOs and insurance companies will tweak these systems so that the underlying algorithms favor reduced cost rather than highest patient quality of life.
Unfortunately, physicians are no more or less computer literature than any other professional group (which is to say, not very), and so we, as developers, have an ethical obligation to articulate very clearly how these systems function, both to the clinicians who use it, and to the public.
Having said this, I would much rather have my physician pull out his handspring and look at survival curves for various drug treatments than to have him give me 'drug x' because that's simply what they 'do' for my condition!
Industry data indicates that a full 20 percent of American physicians already carry hand-held devices, if only to keep track of schedules and stock holdings...
Just what I need when I'm hemorraging--my quack checking his RHAT shares...
Twelve-and-three-quarter inches. Unyielding. This wand belonged to Bellatrix Lestrange.
I work for Lernout and Hauspie. We make voice recognition products specific to healthcare - and have prototype handheld voice recognition devices running Linux on the compaq i-paq. In my own estimation, the cross over is not far away. I'm betting we will release a VR handheld for use in healthcare.
2 6&mode=thread
0 0&mode=thread
0 8&mode=thread.
See this link for healthcare product info at L&H.
See this link for L&H's press announcement about L&H's Linux PDA.
See these slashdot stories about L&H's Linux PDA:
http://slashdot.org/article.pl?sid=00/03/31/14322
http://slashdot.org/article.pl?sid=00/02/05/09282
http://slashdot.org/article.pl?sid=99/11/10/18592
"I'm The Bounty Bear. I will find him anywhere. I'm searching."
well, michael's doctor might not be on the cutting edge, but I just finished an internship this last summer at MD Anderson in Houston (big cancer hospital), and at least a fifth of the doctors i interacted with had some kind of device w/ i/o capabilities -- usually a palm that they used to note things and organize information that they would be putting into their computers later (this is a research hospital). it made them faster, IMO.
I didn't think there was any way for a doctor's signature to get worse... and now, their penmanship is going to be even more cripped when they sign their prescriptions on their little touchpads...
yes. bad doctor joke...
Shameless Self Promotion : Webhosting at Blender Networks.
The tricorder for Palms is here.
Can't live without it. How else would I know if the people I meet are terrestrial or not?
-larsch
I am currently working with an MD designing a desktop/laptop/palm databse application used soley to record information during the exam, track patients, and generate legible reports.
This Doc, and I assume most others who work out of hospitals, has access to a text-based computer system that, among other things, allow him to check on lab results remotely.
He and I were discussing the fact that, while entering in data at the patients bedside is fairly easy, going back and entering lab results as they come in is a major drag.
Does anybody know anything about the computer capabilities at these medical labs and wether or not there is any history of these people allowing third party software vendors to access this information in a standard format like XML or text files? It seems to me that in order for desktop and Palm-based medical applications to be really useful, there needs to be some way for the application to dial into the lab and query the server for the latest lab results.
Of course, the security ramifications boggle the mind.
"The world is a construct of forceful imagination. Those who don't know walk around in the reailties of those who do"
Stating the truth is not flamebait - 95% of my customers are banks, hospitals and organisations with large mission critical databases. Some have even tried using MS NT clustering as a high reliability/availability solution. It has never worked.
Basically the Windows operating system is just not as solid as Unix, and Unix is not as solid as OS/400.
OS/400 can run non-stop, even during upgrades of hardware and software.
Some Unixes can give you 99.99999% uptime
Top documented MS cluster gave 99.2% uptime
This may sound like a very small difference, but when 20 minutes downtime can cost upwards of £4 million, it just makes sense to use a mature OS.
Flamebait - I think not:)
Frog51
I have recently had the opportunity to sit in on a Medical Informatics panel at a Philadelphia area hospital and discussed the role of technology with a cross section of doctors, administrators, and residents. One the largest issues that the residents had was portability. They complained about previous experiments involving laptops because they were cumbersome to bring to the point of care. this is one way in which the PDA's shine, and sub-laptop devices could find a niche. At this hospital they have a set amount of money that is set aside for purchasing new hardware/software for the residents. This could be spent on laptops, PDA's, or sun workstations if they felt so inclined. This makes any decvice a tradeoff for some other gadget. Security is also a large concern because if the patient information is not secure then the hospital is open to many lawsuits. It seems that the use of opensource products should be encouraged but the level of technical expertise is not very high, and there are support questions. the other issue that comes up is the availability of software. What software is out there and being used now?
My husband and I were in the ante-something area at the hospital (the pre-delivery room), and the staff OB had just confirmed that I was really in labor. My husband whips out his Palm to get our OB's home phone number, and the next thing I know, here's the doc pulling his slightly-different-model out and they're doing compare-and-contrast.
Now, while I like techtoys as much as the next geek, at that particular point (contractions every two minutes) I felt it was more important to yell "HEY, CAN I GET SOME DRUGS HERE?"
Slashdot's token middle-aged housewife
I receive my MD in a few months, and let me tell you - I can't imagine big American hospital medical care without a Palm. You have no idea how many times I've sat in the OR, reading the list of medications that a patient has filled out about themselves, and have to use Epocrates (literally the best free program EVER written) to sort out what's going on based on phonetics. Sounds crazy, huh? Trust me, it's an improvement.
Anyways, I think the fact we (doctor-types) get labeled as "always want to do it the old way" is a sign of intelligence. Systems for med info can't tolerate the kind of crap you have to put up with your standard freshmeat development cycles(ie. paper and handwriting may suck, but it works). However, I think once you have an exmaple of a breakthrough and useful and reliable UI, like epocrates and some others, there pretty much >80% incorporation across the resident housestaff at the big hospitals.
Don't forget the network effect when it comes to patient tracking software because of the Palm-to-Palm beaming. Once some programmer-doodz figure out a quick checkbox way to initiate patient records, you'll get widespread acceptance. It really is only the patient record setup time that is the bottleneck now, as I see it. I would kill to have an accurate Palm-based patient census. We're carrying ~10-50 patients per, and right now it's the lowest level team member's (ie. intern) job to type an MS Word file EVERY 3AM with all the updated info.
I've heard from more than one doctor who prefers electronic texts on a handheld not only because it makes access easier, but because of how it makes the patient feel.
Even the best doctors need reference works. But patients expect doctors to be omniscient, or near it. They get anxious when they see a doctor consulting a book before making a diagnosis. A doctor who nods thoughtfully and gazes at the screen of a Visor, on the other hand, seems like a tech-savvy, all-knowing genius.
I write front ends for medical databases for hospitals and larger medical offices and from my experience...
1) Most hospitals DON'T have a lot of money to spend on these things. (Despite what you may think when you get a bill.) If you don't believe me, just ask your next ER doctor about the latest cost cutting measures -- or if you want to hear a more realistic answer ask a NURSE about the latest cost cutting.
2) While PDA's may not be cutting edge technology, 95 percent of hospitals are on the trailing end of the technology curve. (Many of our client are still mainframe or DOS based!) Don't expect this to catch on like is implied above.
-Derek
I work for the IT department in a UK hospital. We have an ever increasing number of (CE) PDAs. They are probably not used for medical things but they are keeping our consultants organised and in the right places at the right times.
Like the rest of the planet we are looking into wireless networking. The UK National Health Service hopes to sort out an electronic patient record for everyone.
Maybe we will see that paperless office one day?
I'll see your Constitution and raise you a Queen.
There's also the matter of ensuring the security of data carried on the
handheld device (or anywhere on a computer system, for that matter).
Generally speaking, security and patient privacy are the reasons why
hospitals and clinics are reluctant to put many types of patient information
online (particulary chart information). If a hacker gets your credit card
number, you generally are not out much (if anything), and you can replace
the number easily. If a hacker gets your medical information (or, more
likely, if some employee at the hospital or clinic decides to look up your
info during the employee's coffee break), it can be well nigh impossible to
undo the damage there. Plus, as mentioned in the article, HIPAA (Health
Insurance Portability and Accountability Act) will require healthcare
providers to take much better care of their confidential patient data (or
face stiff penalties).
This is not to say that paper records are that secure. In fact, it is
probably the case that electronic records can be much more tightly
controlled than paper ones. It's really analogous to airplanes and their
safety. The airlines may have fewer accidents and fatalities per mile
travelled and per passenger, but the accidents that do happen are real
doozies.
Is it just me, or is the idea of software trying to recognise a doctor's handwriting a source of humour just waiting to be exploited©
I recently attended the NYLF Medical Forum in Philly this past summer, where I had the pleasure of getting a three week crash course in an introduction to the medical field. Among some of our visits, we went to various hospitals in which we had a chance to sit down with residents and discuss what their feelings about the field are.
Many of them, though, also took the liberty to comment on the technology being introduced into their field. A surprising number of them were carrying around PDAs of some sort or another, and used them to keep track of the massive amount of data required to be kept by a doctor in a hospital scenerio.
Having worked in the IT field in the medical industry, I can tell you that this will not be happening in this decade. A company I contracted for before 2000 that specialized in upgrading networks in doctors offices showed me a side of the medical profession I have never seen before. We contacted hundreds of doctors up and down the east coast (private practices and some large ones as well) in efforts to bring their systems up to date prior to the Y2K issues. Sounds like a useful service, and we had a fair share of clients, but you would not believe the number of doctors who do not want to use modern technology. Many are using 8088 (I am not making this up) and 286 machines running DOS apps on a monochrome monitor. They would ask if we could get their old machines hooked to the internet, but when they found out it would cost em $500 to revamp the hardware they would freak. Many would state 'I just paid $3000 for this system 8 years ago' and things of this nature. After talking with the sales team and seeing the stats on paper, there are hundreds of doctors in the central east coast area alone with computers that today would not be able to run even the most basic software. Of course when Y2K hit, we had many callbacks because many of the older systems that ran on older mainframes/databases crashed and now they believed the problems we told them they had. Kinda funny, since most just decided to upgrade AFTER the problem, and pay a dozen people to sit around and type in the old records from hardcopies on file. Thats another thing I don't think most people know - the number of companies who LOST their complete network in Y2K and paid people to come in and manual resotre the database from hardcopy, and denied ever having problems (if you think a doctor is going to let you know he lost all the patient records and billing information for the past couple decades you better think again). You would think with the profits they make they wouldn't be so cheap, but as I said before, it's quite amazing seeing an office with a pair of 8088's still running the billing software.
-Sternn