Integrating with the Enterprise
It's one matter to load reference information on a PDA. It's entirely different when you need to integrate the data in hospital databases with the PDA, and be able to transfer back from the Palm to the hospital computing infrastructure, which can often be a mix of hardware types with proprietary back-end databases and other technological hurdles. Companies such as PatientKeeper and MercuryMD provide more than just reference materials. They allow the transfer of patient data, admission and discharge information, chemistries, blood counts, etc.; exchanging information taken directly from the hospital's back-end systems.
Stephen Hau, founder and vice president of marketing and business development at PatientKeeper, a software company that helps hospitals integrate back-end systems with PDAs, says: "Most hospitals will have a variety of systems. Often they don't communicate well with one another and often they are quite old. When we architected the PatientKeeper technology, one of the requirements was to integrate with existing systems." Hau says they have done that by developing applications that use XML as an integration method and also by using HL7, a hospital protocol that helps disparate systems within the hospital computing infrastructure communicate with one another.
CareGroup's Halamka says that working with clinical data on a PDA is a lot harder because it has HIPAA implications. He says they have partnered with PatientKeeper to link their data using XML and display the data on the PDA as a secure Web service. This means the system authenticates who the doctor is before passing along information, and then once the system verifies that the physician has access privileges, he or she can access a variety of clinical data through the PDA. Halamka describes the process using a fictional Dr. Smith. "Dr. Smith's credentials are sent to a secure Web service and verify that Dr. Smith is in fact able to access clinical data. Because we now know who Dr. Smith is, we can then get a list of Dr. Smith's active patients. We can say who was discharged yesterday, who is in the hospital today, and who is going to be pre-admitted and therefore admitted tomorrow, and then taking that list of active patients, we can then go dredge all of the result reporting, then bring to the PDA all of the laboratory results that includes chemistries, blood counts, that sort of thing."
David House, vice president and CIO of information services at Baptist Health in Arkansas says [he has] had positive feedback from doctors using MercuryMD, another company that synchs hospital data with the handheld computers, at his facilities. With this program, doctors have access to recent information on the patient such as lab results and can compare against earlier results to let the patient know right there how they are doing. Previously, they may have to check a record and get back to the patient, but with Palm everything is available during the consultation. House says, "With the Palm you can just look at it and compare the two levels, so they can have a more consultative discussion with that patient and that's very nice. They can handle that interaction in one transaction versus multiple and provide really higher quality to the patient."
Although these types of broader solutions are beginning take hold in medical settings, IDC's Slawsby cautions they have not yet gained widespread popularity. He says, "In general, implementing broad mobile solutions at hospitals, I think is something that is gathering momentum, but it is not yet at the point where it is remotely broadly accepted because there is cost involved, there is training involved, and there is the whole concept of workflow. To what extent are you going to impact the efforts that already exist from doctors and nurses who have processes they have worked on for years?"
Cash or Charge
Another major use for PDAs in a medical setting is capturing charges in a more efficient way. Physicians typically collect pieces of paper with charges during the day and then enter them at the end of the day in a grossly inefficient process that had great potential for losing revenue because of forgotten charges or lost papers. Hau from PatientKeeper says that one of their earliest applications was a charge capture tool. He says, "We started with a charge capture application, the ability to collect professional services charges at the point of care. It may not sound like the sexiest thing in the world, but if you look at how physicians collect service charges, they are using little pieces of paper." He continues, "If you pull certain physicians aside, you will often find they use their coat pockets as a make-shift filing system. It's a total mess, and as you can imagine it leads to financial inefficiencies. You'll find that [papers] get lost, or people just forget to hand them in."
Even when doctors are using a more organized system, they can run into problems. Palm's Buhr explains that when doctors order a lab, they typically do it on a piece of paper with hundreds of categories. Buhr says, "There is a significant amount of data loss where the patient is not ordered the right lab, or that the lab that is ordered is not recorded, and therefore the hospital or physician loses revenue on that because they are not able to bill the patient or the insurance company for it."
According to Buhr, charge capture functionality on a handheld is much more efficient. He says, "What charge capture is about is moving that to an electronic format, where the doctor is holding a handheld, where that form is there, and they are able to order labs and have the information captured and recorded electronically, which basically drives the two most important things: better patient care and reduced costs."
Doctors are constantly on the move and they need their data to move with them. PatientKeeper's Hau says, "If you track physicians in a hospital setting, they are walking 3.5 miles a day. They are not at a desktop; they are really mobile professionals." Because it only makes sense for them to leverage the latest technologies for keeping the most current data close at hand, physicians lead the way in the mobile content marketplace.