May 29, 2007

Mobile Technology: Pint-sized but Powerful
By Mary Anne Gates
For The Record
Vol. 19 No. 11 P. 16

There was a time not so long ago when cell phone use was prohibited inside a hospital. Now, with the advent of 21st-century technology, cell phones, tablet PCs, PDAs, and other handheld mobile devices are not only permitted inside hospitals, they actually serve to enhance patient care.

Combining the latest technologies of small, portable, handheld devices; versatile, easy-to-use software; and an up-to-the-minute wireless infrastructure has helped propel healthcare to a new level. Tablet PCs, PDAs, cell phones, and other devices share a common goal of enabling physicians and other clinicians to rapidly deliver quality patient care while maintaining a record of treatment. Treating patients with today’s technology pulls together patient and clinical information, labs, and other test results in one convenient place: the bedside.

“The clinician can see what is going on with the patient and make a decision on how to treat the patient,” says John G. Doherty, global marketing manager of monitoring solutions for GE Healthcare.

Additionally, a record of treatment, including medications given and procedures performed, goes with the patient and is invaluable to caregivers at the next level of care.

“It’s really important to have all the care documented so that providers at each level of care can see what’s been done. It helps them to provide the best care possible,” says Tommy Joe Morris, director of deployment of health technologies and support programs for the U.S. Department of Defense (DoD).

Morris developed the Battlefield Medical Information Systems-Tactical (BMIST) application to aid Army medics in treating soldiers and better documenting the treatment medics provided.

Technology Reports for Duty
As recently as the 1990s, Army medics carried heavy packs containing medical reference manuals and a Leader’s Book used to document the diagnosis and medical treatment of soldiers.

Stationed in Macedonia during that time, Morris was one medic unsatisfied with the cumbersome way of providing medical care and the haphazard system of record keeping.

In response, Morris developed the initial BMIST prototype in July 2001. “The intended customer was the Special Forces medic,” he says. “The original objectives were to develop a point-of-care handheld application that gives access to critical medical information to empower providers with the information and support tools necessary to provide the best care possible to our service members. It is extremely important having a tool that intuitive and one that can pretty much be used in any environment.”

According to the U.S. Medicine Information Central, BMIST is a “multiplatform software system” collecting, standardizing, reporting, and analyzing medical data. Further, it stores clinical information and medical references. For example, BMIST technology can run on PDAs.

Currently, BMIST tablet and laptop prototypes are being evaluated at Madigan Army Medical Center in Tacoma, Wash. Ryder Trauma Center in Miami is also expected to test prototypes, says Morris.

“We do different pilots so that we get feedback on the system and refine it to more closely align with our business practice to get relative tools to help provide the best care possible,” he says.

Morris estimates current BMIST use within the DoD at more than 20,000 units worldwide, including Iraq and Afghanistan.

BMIST Goes Civilian
BMIST interfaces with other systems, such as sensor devices and physiologic monitoring devices. As those and other devices come to fruition, it can be plugged in and become part of a multimedia electronic medical record, says Morris.

“This type of information goes from the point-of-care information all the way to the VA [Hospital]. It allows timely, accurate quality care to our service members,” he says.

BMIST technology and civilian partnerships are in progress. “We’re actually working with Health and Human Services and others,” Morris says. “Commercially, we’ve licensed it out to other countries like the UK [United Kingdom]. The UK is not just using it for their military, [it’s] using it for [its] health ministry.”

What Physicians Want
Blending established methods with new technology appears to be favored by many physicians.

“We know physicians want mobile devices that mimic the traditional pen-and-chart model but integrate key technologies to make patient data collection at the point of care more efficient—like barcode and RFID [radio frequency identification] readers and a camera—to allow physicians to spend more time with patients,” says Joel French, vice president of Motion Computing and general manager of its healthcare business group.

Additionally, patients often require medical intervention when their physician is away. Bedside support and patient monitoring can be especially useful during such emergencies.

Physicians want to view the event as it occurs. Whether it is a PC, PDA, or cell phone, observing what is going on with a patient in real time is important. “They [physicians] want to see what is happening now, not what happened five minutes ago,” says Doherty.

Besides real-time viewing, another important feature of reliable handheld devices is high-screen resolution. Additionally, devices that can withstand being dropped receive high grades. Doherty says he recently dropped a PDA and expects repairs to cost $300.

How Physicians Use the New Technology
According to The Internet Journal of Medical Informatics, PDAs are currently used for the following medical purposes:

• access of educational information (e-publishing);

• libraries (drug references);

• databases (case tracking, performance evaluation);

• medical records (patient tracking);

• medical calculators;

• monitoring devices (electrocardiogram, pulse oximetry);

• drug prescriptions;

• coding and billing;

• communication (combined handheld–cellular phone, PowerPoint presentations); and

• personal organizer (day planner, contact lists).

Eighty percent of the respondents in an American College of Physicians and American Society of Internal Medicine survey indicated that they used their PDAs to access drug information; 32% to reference for normal laboratory values; 21% to read medical educational content; and 21% to streamline coding and billing. According to HIMSS, the total number of hospitals nationwide reporting use of handheld devices is 1,395, or 27.5%.

HIPAA Compliant
Today’s handheld technology is designed to be HIPAA compliant and protect a patient’s private information. Many devices also allow only limited access.

For example, a healthcare worker responsible for treating a patient would have access to the patient’s medical records to more effectively treat them, but they may not have access to the demographic information. “This [feature] allows limited access to those who need to know,” says Doherty.

What Nurses Want
As innovative and multifeatured as most devices are today, the ultimate do-everything gadget isn’t available.

“There is no perfect device,” says Doherty. “What a doctor wants is very different from what a nurse wants. It’s a matter of what information you need.”

For example, the C5 Mobile Clinical Assistant by Motion Computing is designed primarily for nurses. “We’ve brought to market the first mobile clinical assistant—a new computing category created by Intel—in February 2007 called the C5. The purpose of the C5 is to integrate into a clinician’s existing workflow, capturing and providing key point-of-care data at the bedside in order to ease workload and improve the quality of care,” says French.

The C5 was designed with the healthcare environment in mind. The goal was to fit in with the clinician’s everyday workflow and improve clinician productivity. The top line advantage of the C5 is quick, accurate, and secure access to patient information at the bedside, says French.

Making It All Work
One-on-one discussions with nurses and clinicians on the frontline revealed potential drawbacks to integrating portable devices in a healthcare setting when it isn’t done properly, says French.

To avoid such pitfalls, clinicians and other healthcare staff offer suggestions for implementation, including the following:

• provide proper training;

• eliminate the comingling of computerized information and paper-based medical charts;

• have wireless networks sufficient to deliver the performance required for highly mobile point-of-care application usage;

• integrate a device that allows clinicians to maintain eye contact with patients while charting; and

• provide a 1:1 ratio of devices to clinicians per shift to ensure information access and remove wait times.

Connectivity Is Crucial
Supporting the latest wireless devices and assuring their reliability requires a powerful yet flexible infrastructure. GE Healthcare and MobileAccess have joined forces to implement an infrastructure that enables physicians and other healthcare staff to use the latest technology available to provide optimal patient care.

“Our clients are looking for collaboration between clinical systems, software companies, and computer manufacturers to enable key integrated technologies within an application. An effective and reliable wireless infrastructure helps bring this collaboration and these technologies to life,” says French.

Keeping Patients Connected
Besides various handheld devices that currently require a reliable infrastructure, there are many in-house technologies being designed to enhance patient care that will also depend on a robust wireless connectivity being built into a healthcare facility.

“Promising applications include computerized physician order entry, which reduces patient wait times and improves accuracy, and wireless medical telemetry service, which simplifies care by delivering vital sign information to caregivers on the move,” says Lou Martinage, director of marketing and business development for MobileAccess. “However, without complete and seamless wireless coverage throughout the hospital, these applications are stripped of their feature-rich capabilities and represent a lost opportunity.”

Keeping Track of Equipment
In addition to helping doctors, nurses, and other staff more effectively care for patients, a wireless infrastructure can be designed to keep track of costly, portable medical equipment.

“Another promising technology is advanced, real-time, location-based services. Inventory management/location-based asset tracking applications track the location of valuable portable equipment so that hospital assets can be located quickly, saving staff search time and reducing the risk of loss,” says Martinage.

The Virtual Hospital
One component of effectively running a large brick-and-mortar hospital calls for hands-on staff to access equipment and patient records quickly. Within these real-world hospitals is an unseen seamless infrastructure of wireless technology bringing people, technology, and equipment together.

“Every day, new mobile applications are changing the way hospitals leverage people and assets to deliver care,” says Martinage. “As mobility untethers caregivers and creates a virtual hospital, there are more mobile applications to choose from; however, all of these promising new technologies need an adaptable pipeline and broader wireless deployment in order to function properly.”

From the CEO to the part-time patient care assistant, it is expected that as the needs of a hospital change, reliable connectivity to the wireless infrastructure must also change to meet new demands. Yet, the connectivity must remain available while upgrades to the system are in progress.

“From a reliability standpoint,” says Martinage, “we can typically guarantee an agreed-upon signal strength throughout 95% of a facility. From VoIP [voice-over Internet protocol] to real-time, location-based services, built-in interference mitigation ensures that each wireless signal is groomed to meet all device and application requirements.”

If wireless coverage is compromised, the end-to-end management interface proactively identifies and resolves these issues with local area network-like simplicity, he says.

“As hospitals evolve from tracking data to connecting people and assets to outcomes, wireless infrastructure is becoming a powerful tool in transforming medicine,” says Martinage. “Ultimately, hospitals benefit from seamless connectivity because mobile applications can provide competitive advantage, fuel new operational efficiencies, and improve patient care.”

— Mary Anne Gates is a medical writer based in the Chicago area.

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A Sampling of Available Handheld Technology

MedTab, a pocket-sized (5.5” X 7.5” X 0.5”), lightweight (12 ounces) tablet intended for bedside use by Emano Tec

Features include the following:

• ruggedness — built to sustain a 30-gram impact;

• washable — can be disinfected;

• touch screen — includes pen for notations;

• high-resolution display — 1024 X 768 pixels; and

• Intel 624 megahertz processor.

The C5 Mobile Clinical Assistant, lightweight with Speak Anywhere technology by Motion Computing

Features include the following:

• capture data directly via handwritten or dictated notes;

• built-in wireless features enable real-time updates;

• easy to disinfect;

• ergonomically designed for a healthcare setting;

• integrates key technologies for data collection, including a radio frequency identification scanner and bar code reader; and

• provides embedded security safeguarding patient information.

The Vocera Communications System enables instant, wireless, hands-free voice communications that users control with naturally spoken commands

Features include the following:

• the Vocera System software to control and manage all call activities; and

• the Vocera badge, a wearable, voice-controlled communications device that operates over the wireless local area network.

Hill-Rom’s COMLinx Nurse Communication Module integrates with Vocera

Features include the following:

• receive patient calls directly on Vocera badges;

• see call type, room number, and bed number;

• call back patients using a single voice command;

• receive predefined or free-form text messages from the unit secretary and respond with a single voice command;

• receive alert notifications that show call type, room number, and bed number; and

• receive equipment alert notification on Vocera badges.