21st Century Practice: Sleight of Hand — Palm-Top Computers Make Big Promises To Medicine
Schoolchildren who write test answers on their palms risk expulsion for cheating. But tech-savvy physicians today are being encouraged to put megabytes of clinical information in the palms of their hands.
These tiny computers offer physicians immediate access to far more data than they can possibly scribble on their palms - or keep in their heads. Proponents say that these machines hold the key to improving patient safety, reducing liability insurance premiums, and streamlining medical office operations. Slightly larger than a deck of cards, the new devices go by several names: handhelds, palm-tops, PDAs (personal digital assistants). They weigh five to 10 ounces and sell for $150 to $800. By 2005, the one leading e-health researcher predicts, "these devices will be commonplace."
The basics
All handheld computers offer several common applications: address books, appointments, to-do lists, calculators, time-wasting games, and e-mail programs. All of them can "sync" to your PC through a cradle or infrared beam. Some have color screens, some provide wireless e-mail, and some have audio and video players. All of those add cost and weight.
The screens are small (obviously) but readable. Data entry is tedious, but some models have optional portable keyboards. Memory and processing speeds vary - the biggest determinant being the price. The two primary operating systems are the Palm and the Pocket PC. Palm is generally faster and simpler, but many Pocket PCs run slimmed-down versions of popular Microsoft programs such as Word and Excel.
Clinical applications
For most handheld users, the joy lies not in what they can put into these petite processors but in what they get out of them. An almost endless supply of reference applications is available to download from the Internet for free or for a modest fee. These include:
- Pharmaceutical guides, which cover drug names, dosages, side effects, and interactions;
- Reference handbooks that provide treatment guidelines and diagnostic aides;
- e-versions of popular publications such as Harrison's Principles of Internal Medicine and Stedman's Medical Dictionary ; and
- Medical calculators.
Users also can subscribe to some of their favorite medical publications, whose new issues are automatically downloaded each day, week, or month from the Internet. The American Medical Association's AMNews and TMA's EVPGram are already available in this format, as are abstracts from journals such as Lancet and The New England Journal of Medicine . TMA is negotiating a contract to offer its "Legislative News Hotline," Action , and even parts of Texas Medicine for palm-top reading.
In the office
Perhaps the most promising handheld applications for physicians fall under the category of practice management. Programs now available will track patient data, including history and physical, and lab results. Others focus on coding and billing, ensuring that the office visit really is a 99203 and checking for errors or omissions before producing a claims document.
Prescription-writing systems often assemble formularies, patient allergies and potential drug interactions, physicians' preferences, common dosages, and brand vs. generic information into a single point-and-click program. The resulting, and legible, scrip then prints out at the office or travels via fax or Internet to the local pharmacy.
Very few of these applications, however, will stand (or sit) alone in your PDA. Most are simply options that practice management systems vendors offer for purchasers of their products. The upside of such a package deal is that it brings the data collection device into the point of service (something you might call an exam room), thus minimizing transcription and data entry costs. The downside, of course, is the expense of a brand new practice management system (more on that in future columns.) Some vendors, however, will support specific functions (like billing or prescription writing) on a monthly subscription basis.
A word of caution
Some vendors are offering free handheld computers to physicians who sign up for their billing or prescribing services. Some even offer these services for free. The catch? All you have to do is let them have all of that computerized data about your prescribing and billing practices.
Privacy advocates also worry about the confidentiality of patient records, especially those transmitted via wireless systems or between PDAs and hospital computers. The new HIPAA regulations are supposed to protect medical records, but none of the palm-top application developers have proven that their systems meet those standards.
Resources
by Steve Levine, TMA Communication Director
Oct. 4, 2001